Management of post-concussion headaches

Why does it happen?

In short, a concussion causes brain cells to be temporarily damaged.  Thankfully, these brain cells will heal!  Until they heal, communication between brain cells is more difficult.  This difficulty results in concussion symptoms because the brain is having to work harder, with injured connections and less energy, trying to perform its usual numerous actions.   This very helpful blog post explains exactly what happens in the brain that causes headache: What happens to your brain?

How else could this symptom manifest?

• Trouble with concentration
• Increased irritability
• More emotional

Are there any helpful medications/supplements?

“Fortunately, your brain can repair and heal itself! It is valuable to remember that your brain can be retrained. Networks between neurons can be reshaped, rebuilt, and strengthened.”  With time, care, and occasionally with medications and natural health products, quality of life and symptoms will get better.  Though this list is not extensive, these are a few medications/supplements to discuss with your concussion provider that may be helpful for your child’s headaches:

• Omega-3’s (while not targeted to a specific symptom, helpful in overall concussion recovery)
• Multivitamin (If lacking a well-balanced diet, a daily multivitamin is important since good nutrition is essential for healing. Also, it’s important to have adequate Vitamin D levels at baseline as Vitamin D deficiency can lead to prolonged recovery - More info on Vitamin D. )
• NSAID’s like Ibuprofen or Aleve (once it has been >3 days post-concussion)
• Magnesium
• Butterbur root, brand name Petadolex (most helpful for those with history of migraine headaches)
• Amitriptyline
• Cyproheptadine (most helpful for those with history of migraine headaches)

The FDA does not regulate Natural Health Products (NHP’s) in the same way as prescription medications and therefore when choosing a NHP it is important to consider interactions with other NHP’s and medications, whether the product has undergone 3rd party testing (like that done by Consumer Lab), and the number of ingredients in each product.   The companies we typically trust, because they conduct 3rd party testing and have fewer added ingredients include:  Metagenics, Pure Encapsulations, Nordic Naturals, Barleans, Kirkland Signature, NatureMade, and Neurobiologix. 

What else can we do?

1. Encourage your child to listen to his/her body. If an activity he/she is doing is not making the headache worse, it is likely okay to continue (assuming the activity has no risk for another brain injury).  If the headache is worsened by an activity, it is best to stop, take a break, and then try again.  Listening to his/her body, rather than “pushing through” an activity despite worsening symptoms, will greatly help recovery.  An easy rule of thumb is not let their headache reach a number >5/10.  So, if for example they start their day with a headache rated 2/10 and schoolwork causes it to go up to a 4/10, it’s okay to keep pushing; however, if that headache gets to a 5 or greater, stop and take a break. 
2. Stay home from school until awakening without a headache, then start with half-days and progress to full school days as tolerated.
3. Minimize activities that may worsen symptoms; this could include using screens, riding in the car, being out in direct sunlight, spending time in crowded places, etc.
4. Once headache triggers are identified, if they can’t be avoided, try something to lessen the intensity of the trigger.

• For light sensitivity triggering headache try wearing sunglasses and/or a ball cap to school and in the bright lights. If this sensitivity is caused by screens try, turning the phone on “night shift” to decrease screen brightness. Tinted transparencies may help when looking at computer screens and lights. Gray tints help with all over light sensitivity.  Rose tints help with fluorescent lights, LED lights, and computer screens.  Amber tints help improve contrast sensitivity. Blue tints help block low wavelength light.  These can be found on Amazon.com by searching “colored overlays for reading or dyslexia.”  
• For noise sensitivity triggering headaches try wearing ear plugs in class and in loud crowded places. Try to eat lunch in a quieter place at school. 
• For crowded spaces triggering headaches try to avoid going to places such as the grocery store or shopping areas. In school, ask to leave class early to get to the next class early to avoid the loud, crowded hallways.

5. Though parents know our children so well, we can’t read their minds. To complicate things, their concussion symptoms are often not obvious us, unless they are specifically verbalized outload.  Because of this, it can be easy to doubt that they truly feel the symptoms they are reporting.  It is so important that we validate them, letting them know that that we believe them. Then, it is important to encourage them that these concussion symptoms will resolve and that they will return to normal.

Most children recover from a concussion in 3-4 weeks, and during that time, symptoms typically improve very gradually.  If this is not the observed trend, or symptoms are worsening, it is very important to talk to your concussion provider. 

References:

https://www.cdc.gov/traumaticbraininjury/pdf/pediatricmtbiguidelineeducationaltools/2018-mTBI_Recovery-508.pdf

https://www.concussionalliance.org/what-happens-to-your-brain