Headache

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• headache after stroke
• headache after traumatic brain injury
• migraine
• cluster headache / chronic cluster headache
• tension headache
• pain due to whiplash
• headache from the neck / cervicogenic headache
• supra orbitalis neuralgia
• withdrawal headache / rebound

Headache is one of the most frequently mentioned complaints after brain injury. More than 41% of people with different types of brain injury have headache complaints in the first year.

Acute phase and chronic phase
Immediately after a brain trauma, the headache may be caused by the scar, by blood clots that still provide pressure and by fluid in the brain.
Headache that occurs for a long time after the injury can occur, among other things, due to the change in the brain structure due to the injury, injury in the neck and skull, due to stress and tension, due to overload, neurofatigue, overstimulation and it can even be caused by medication.
Headaches may come and go. They may completely affect someone's functioning, for example cognitively.

Not everyone is left with a headache as a residual symptom.

Stroke and headache

Chronic headache is estimated to occur in 10% of patients after a stroke. Headache in the early period of a stroke is a predictor of headache six months after a stroke. People with a history of tension headaches or vascular headaches are more likely to develop headaches after a stroke. (Vascular headache is an outdated term used to refer to certain types of headaches, including migraines, cluster headaches, and fever associated with another condition.)
The cause of headaches after a stroke is not fully known. The stimulation of nerve cells in the fifth cranial nerve (trigeminal nerve) is one possibility. These nerve cells (neurons) ensure the contraction or dilation of the cerebral blood vessels (trigeminovascular system).
The damage or changes to the blood vessels and the subsequent inflammation or disruption and/or stimulation of pain pathways could be a cause.

Traumatic brain injury and headache

Migraine-like headaches are noted in both mild and severe traumatic brain injury, as well as in patients with whiplash injuries. NB! Not everyone has a headache! Immediately after a brain trauma, the headache may be caused by the scar, by blood clots that still provide pressure and by fluid in the brain.
In addition to headaches, pain in the neck is also frequently mentioned. See also the paragraph cervicogenic headache (headache from the neck).
Particularly in people with severe traumatic brain injury, but also patients with whiplash or mild traumatic brain injury such as concussion. It must be ruled out whether someone has a neck hernia or broken neck. Even after years, people report having daily headaches.

There are several types of headaches caused by brain injury.

Migraine

Attack-like headache mild to severe. It varies per attack.
Migraine has different phases. These phases may overlap.

• The prodrome phase: 24-48 hours prior to an attack, one may experience complaints of:
  • Fatigue
    
  • Be less able to think well
    
  • A change in mood. More sensitive, happier, more irritated, etc.
    
  • Muscle stiffness in the neck
    
  • Stomach and intestines (gastrointestinal complaints)
    
  • Feeling like eating certain things
    
  • More sensitive to light and sound

• The aura phase: This phase occurs in 1 in 4 people. It usually comes on gradually over about 5 minutes, lasts about 1 hour and then disappears. Aura refers to temporary changes in sensory experiences (seeing, smelling, feeling) or temporary speech and language symptoms. Complaints that may occur:
  • Seeing nothing on one side (hemianopsia)
    
  • Sensory hallucinations
    
  • Flickering patterns (flicker scotomas), seeing spots that slowly grow larger, change, become a sawtooth shape or move towards the outside of the eye
    
  • Blurred vision, double vision, seeing waves or bright lines, seeing light
    
  • Temporary hearing loss or tinnitus
    
  • Dizziness
    
  • Inability to feel or move a part of the body (for example, numbness in the tongue or on one side of the body)
    
  • Tingling, numbness or burning pain in the face (for example the lips), hands or feet
    
  • Less strength in one side of the body

• The postdrome phase: In this final phase, which lasts about 1 to 2 days, a feeling of exhaustion or a hangover predominates. Although some people feel exuberantly happy or very pleasant. Cognitive tasks, such as thinking and understanding, can be somewhat more difficult.
• There are people who have migraines without a headache. This is sometimes called a 'silent migraine', in which aura symptoms occur without a headache. This can vary from a few minutes to an hour.
• Hereditary factors, hormonal factors such as menstruation and external factors play a role.
• Migraine in itself is a brain disorder (neurovascular disorder).
• Studies show that migraines may be a risk factor for structural changes in the brain.

In 2012, research published in the Journal of the American Medical Association (JAMA) showed that very small abnormalities similar to cerebral infarctions were found in just under 10% of migraine patients.
In the cerebellum of the posterior bloodstream area come small
Infarctions are more common in migraine patients than in a healthy population.
Abnormalities in the white matter (white matter abnormalities WMAs), infarct-like lesions (ILLs), changes in gray and white matter (GM, WM) and cognitive damage were also found.
It was striking that white matter damage did occur in women (without aura during migraine) and not in men.
Brain infarctions due to migraine with aura also occur.
Other research showed small brain changes; decrease in gray matter, mainly in the visual cortex areas (V3 and V5), compared to control groups.

See for more information here. 

Cluster headache

It is not known whether this headache can be triggered by brain damage, but we cannot rule out this cause.

• Strictly one-sided most severe headache
  
• Intense piercing stabbing flaming pain around and behind the eye,
  
• Sometimes accompanied by a watery eye or drooping eyelid, runny nose or red eye. This does not happen to everyone.
  
• Being unable to sit still due to pain does not happen to everyone
  
• Attacks lasting from 15 minutes to hours
  
• Cluster attacks can last several weeks to months, with the attack frequency varying from one every two days to eight per day/night. After such a period, the patient can be attack-free for months to several years.
  
• Rarer is the chronic cluster headache form (approximately 15% of people with this headache) in which there are no attack-free periods. This most serious form of headache can affect your entire life.

See for more information here.

Tension headache

The term tension headache is misleading. Neither tension nor muscle tension is always the cause.

• A pressing, pinching pain as if there was a band around the head or on either side of the head
  
• Mild to moderate headache, less severe than migraine
  
• Often sensitive neck, shoulders and skull but rarely increased muscle tension in neck and shoulders,
  
• Sometimes light and sound sensitivity, but that is not standard with tension headaches
  
• Sometimes reluctance to eat
  
• Activities can still be carried out
  
• Tension is not necessarily the cause of this pain, but it can worsen with tension or incorrect posture
• Lasting minutes to days; episodic form (less than 15 days per month) and a chronic form (more than 15 days per month)

Pain in the neck due to whiplash

Neck pain and headaches are two of the most common complications of whiplash injuries. One study showed that an average of 60% had headaches within seven days after a whiplash injury. Twelve months after the whiplash injury, an average of 38% of patients still had neck pain.
See also the paragraph cervicogenic headache (headache from the neck). Read more on the page whiplash/WAD.

Cervicogenic headache

Pain from the neck

• Nagging, non-throbbing headache, sometimes in attacks
  
• Moderate to severe headache
  
• Headache complaints from the neck or back of the head, sometimes radiating to the frontotemporal area (side of the forehead) and above the eye
  
• On one side of the head, sometimes both sides
  
• Neck movement or positioning can make the pain worse
  
• Lasting hours to days
  
• Sensory overstimulation can, among other things, lead to temporary changes in the control of muscle groups from the cranial nerves
  
• This can cause muscle cramps and pain

Supra-orbital neuralgia

Nerve pain caused by damage to the supraorbital nerve

• One-sided headache of the forehead and eye
  
• Tingling, pricking, burning pain
  
• Pain may worsen when touched
  
• A test block of the nerve causing this pain can confirm the diagnosis

Withdrawal headache / Rebound headache

Sometimes medications taken for headaches or other pain can cause rebound headaches.
When pain medications are taken daily on a regular schedule, it can cause headaches if one or two doses are missed.
A 'rebound' headache can also develop if a person reduces the amount of daily caffeine such as in coffee, tea or energy drinks.

• Chronic headache
  
• Pressing pain
  
• Lasts all day
  
• Worse in the morning and with exertion