Headache after a traumatic brain injury: what does it mean?

Emergency numbers
United States: 911
United Kingdom: 999 or 112
European Union: 112
Elsewhere: your local emergency number

Short answer. Headaches are common after concussion or another traumatic brain injury. A headache alone cannot tell you what has happened in the brain. How it changes, accompanying signs and the circumstances of the injury are essential. Persistent pain deserves assessment; pain that worsens after a recent injury may be an emergency.

Important. After a blow to the head, vomiting warrants an immediate call to emergency services, in keeping with the French public guidance used here. Also call for a headache that worsens and does not go away, increasing confusion, difficulty waking the person, a seizure or unusual weakness. These signs do not need to occur together.

Why might your head hurt after an injury?

Post-traumatic headache does not have a single cause. After a brain injury, different mechanisms may be involved, sometimes together: the effects of the injury, neck pain, muscle tension, disrupted sleep or factors that perpetuate pain. Two people may therefore use the same word, headache, to describe very different experiences.

For one person, the pain feels like pressure across the head. For another, it throbs, sometimes with sensitivity to light or noise. This variety explains why a pain score out of ten alone cannot capture the situation.

When indicated, a CT scan looks in particular for acute injuries requiring treatment. A normal CT scan does not mean concussion symptoms are invented; equally, the intensity of a headache does not allow you to decide for yourself that imaging is unnecessary.

When does a headache become a warning sign?

The most important distinction is between pain that is present and pain that is worsening or accompanied by a concerning change.

After a recent head injury, a headache that grows stronger and does not ease should prompt emergency help. The same applies if the person vomits after the injury, becomes less alert, has difficulty speaking, weakness on one side of the body, a seizure or markedly unusual behaviour.

A persistent headache, even without these major warning signs, warrants appropriate medical assessment. Taking anticoagulants, amnesia, loss of consciousness or a significant accident mechanism also affects the level of concern.

For example, having a moderate, stable headache and being able to explain exactly what happened is different from having pain that has increased over an hour and being unable to find your words. This comparison helps communicate facts; it never replaces medical advice.

Which details are useful to tell the doctor?

When there is no sign requiring an immediate emergency call, note a few simple points:

• Onset: did the pain begin straight after the impact or later?

• Pattern: is it easing, returning or increasing?

• Context: was there loss of consciousness, amnesia, nausea or vomiting?

• Effect on everyday life: does the pain disrupt sleep, reading, conversations or ordinary activity?

• Medication: which medicines are already being taken, and how often?

This brief description is more useful than a string of vague adjectives. Saying that the pain returns after twenty minutes of reading and eases with a break gives the healthcare professional a specific situation to explore.

What if the headaches continue?

Some people have headaches that persist or recur long after a traumatic brain injury. Treatment depends on the type of pain and other associated difficulties. MSKTC notes that headaches can interfere with concentration, activities and everyday recovery.

While waiting for appropriate advice, it helps to identify situations that actually worsen symptoms, without trying to give up all activity in the long term. A gradual, individualised return to tasks can be discussed with the healthcare professional. Report fatigue, sleep problems, neck pain or visual difficulties if they accompany the headaches.

Avoid adding or changing painkillers yourself when you take them frequently: some patterns of use can perpetuate headaches, and some medicines are unsuitable in certain circumstances. A healthcare professional can review what you take, the doses and other prescribed treatments.

A common question: do you always need a CT scan?

No, not routinely. The decision to perform a CT scan after a head injury relies on clinical assessment and specific criteria: level of consciousness, neurological signs, vomiting, risk factors and the circumstances of the injury. A headache may require a consultation without necessarily calling for the same course of action for everyone.

A useful question to ask is: which findings from my examination support or do not support imaging, and which changes should I act on?

Key points: the presence of a headache alone does not determine urgency; how it develops and its context matter. If it worsens after the injury, do not wait. If it persists, seek an appropriate assessment rather than getting used to suffering in silence.