While everyone may experience headaches at some point in their lives, those who suffer brain injuries are especially likely to have chronic headaches & migraines. Some headaches feel as though they originate deep within the skull; others seem to start externally and penetrate to the brain’s very core. However, while it is the brain that perceives the discomfort of a headache, the brain itself is actually impervious to pain. What causes the experience of headache pain are pain sensors located in the arteries, nerves, and muscles of the head, as well as in the meninges (the thin membranes covering the brain), that have become distended, inflamed, or compressed.
Types of Headaches
If you suffer from tension headaches, you are already no doubt quite familiar with the two-sided sensation of squeezing or pressure that feels like a too-tight band around your head. The tightness continues for the duration of the headache, and may be accompanied by facial or back pain, particularly if you had a whiplash injury.
Tension headaches can be caused by worry, stress, poor posture, overwork, or inadequate ventilation. They often start late in the day and they may prevent you from falling asleep. The pain may fluctuate from mild to moderate in intensity, but normal activity may not be affected. This is because physical activity does not generally aggravate tension headaches (in some cases, it may actually help.
Migraine headaches last from four to seventy-two hours and are experienced as an aching, pulsating, throbbing sensation at the forehead or temple. They may affect only one side of the head, or generalized areas of the skull. The physical effects may vary from one attack to the next or even within a single episode, and can include nausea and vomiting, muscle weakness, numbness, phonophobia (abnormal sensitivity to noise), photophobia (abnormal sensitivity to light), and osmophobia (abnormal sensitivity to smell). Migraines are typically intensified by physical activity and are often relieved by sleep.
Sometimes, migraines are preceded or accompanied by a set of sensory symptoms called an aura. An aura can include the perception of sudden brightness, jagged flashing lights, and/or blurred vision, and may also trigger problems with numbness, initiating movement, word-finding, speech, thinking and reasoning, and disorientation. Most auras occur twenty to sixty minutes prior to the onset or headache pain and last for twenty minutes or less.
This type of headache is associated with head trauma, and can arise months or even years after the original injury. A post-traumatic headache is not one specific type of headache, but rather can be a composite of a tension headache, atypical migraine, and neuralgic (nerve-related) head pain. The pain occurs when the formation of scar tissue, usually at the site of head trauma, renders the nerve-cell fibers there unable to transmit information in the normal fashion. This disruption of impulses can cause the area of injury to become extremely sensitive, in a manner sometimes compared to that of the “funny bone” behind your elbow. The neuralgic component of this type of headache causes a burning or tingling sensation that radiates from the point of injury. The discomfort increases if any pressure is placed on the area, even pressure as light as a fingertip-touch or gentle combing. The pain can be continuous, but, fortunately, most such headaches disappear within a year.
Cluster headaches are thought to be related to migraines. These severe headaches occur occasionally after mTBI, usually if injury to the back of the next causes nerve damage and shooting pain or muscle spasms. A typical cluster headache appears suddenly and without warning, generally at a specific time of day, such as an hour or two after you fall asleep. The pain is an intense, steady, burning, penetrating sensation centered around or behind the eye and affecting only one side of the face. The involved eye may droop, tear, or become bloodshot; the cheek may be flushed; and the nostril on the effected side may be stuffy or runny. During an attack, symptoms may fluctuate from one side of the head to the other.
Cluster headache pain is quite severe and generally lasts from fifteen minutes to three hours. After that, discomfort may return in “clusters” of one to three headaches per day. Sometimes cluster headache episodes alternate with periods of remission, but in some 20 percent of cases, the pain is chronic (occurring daily for a year or more). These headaches can be triggered by cigarette smoking, alcohol consumption, extreme emotion, overwork, or even unaccustomed relaxation.