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Post Traumatic Headaches - Life After the Car Accident


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Many times after a car accident people will have initial neck pain, are seen in the emergency room and treated. If the injuries are not life threatening they are sent home with some medication and told to rest. Unfortunately, many will start to have headaches, even if they have never had headaches before. Those with a history of headaches will find their headaches are getting worse.

Most of the time the headache will dissipate over a week or two and everything will be fine.

But what if the headaches don't go away? What happens and what do people do if the headache gets worse? Post traumatic headaches that get better in four to six weeks are considered acute headaches, but those that stay at the same pain level, start to get worse, or go beyond six weeks are more concerning. The headaches may be all over the head and moderate in pain with breakthrough stabbing, throbbing pain on one side. This more severe form of headache is associated with migraine symptoms and indeed is a migraine.

At this point most people will reach for the over the counter medications such as Excedrin or Tylenol.

Failing that, they may try the medication the doctor in the emergency room gave them and most of the time these treatments are quite successful. However, there is a certain percentage of people who will not respond to this treatment and as a result will start taking more and more medication. The headaches will begin to get worse for two reasons.

First of all, the medication will start enhancing the headaches and cause a condition known as analgesic rebound headache syndrome. In this case, the headache pain goes up and the person grabs the Excedrin which brings the headache down a bit. But, as the medication wears off, the headache starts getting bad again. More medication, more bouncing up and down in pain levels.

Eventually, the medication stops working but the person still keeps taking it in desperation because they don't know what else to do. They might got to their doctor and get stronger drugs, such as Lortab but this only makes the situation worse.

Secondly, the medication used at this point is all wrong. Post traumatic headaches respond best to low doses of tri-cyclic anti-depressants such as Elavil or Pamelor.

Elavil is generally accepted as being the best medication, but most doctors make the mistake of using migraine doses (10-50mg). Unfortunately, post-traumatic headaches do not respond to this dose but most people do respond when the dose is slowly titrated up to 75-150 mg. Fortunately, this medication is also excellent for any associated neck pain and spasms!

The breakthrough migraines are treated just like that. . like migraines.

A small dose of an anti-seizure drug may also be necessary with triptans (Imitrex or Maxalt) for when the pain is bad.

Don't forget, like all other headache syndromes, lifestyle is very important. Regular sleep cycles, good diet and exercise as tolerated will all help the headaches get better. In this particular case, however, the vitamins and herbs used to successfully treat migraines do not have much of an effect on post traumatic headaches.

None the less, many people do want to try them to help the migraine component.

The key to post traumatic headache syndrome is to find a headache specialist and be patient. If the headaches are severe, chances are that it will take several months for any one treatment to have an effect. Most people are not aware of this fact in headache treatment, so they tend to start and stop treatments after a few days or weeks and become discouraged. The longer the brain has the treatments on board, the greater the chance it will heal.

Mary K. Betz, MS RPA-C is a practicing Physician Assistant in neurology who specializes in headache medicine. For more information visit


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