Headache is a common result of head injury and it might persist for months or years following even mild head trauma. Although it is most frequently associated with a variety of symptoms such as dizziness, insomnia, difficulties in concentration and mood and personality changes, headache dominates the clinical picture. In most patients, the frequency and severity of the headache diminishes with the passage of time, and the headache usually disappears within six to 12 months. There appears to be no relationship between the severity of injury and the severity of post- traumatic headache.
The most frequent cause of chronic headache after trauma is muscle contraction, specifically sustained contraction of the muscles of the neck and scalp. Another type is characterized by vascular changes that may give rise to a vascular headache that can pulsate. These headaches often take on the characteristics of migraine.
An understanding of psychological factors involved is of great importance in post- traumatic headache for the head has a symbolic significance and injury to it often generates more anxiety, fear and resentment than injury to other parts of the body. The accompanying muscle contraction and vascular changes compounded by emotional reactions may produce further anxiety and lead to a self-perpetuating cycle.
Head pain generally responds to the non-narcotic analgesics while the emotional reactions may require the short-term use of tranquilizers or antidepressants. Physical and manipulative medicine may also have a useful role in the treatment of chronic post-traumatic headache patients.