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Q. After a concussion, I experience pain in the back of my head. What to do?

Answered by
Dr. Hitesh Kumar
and medically reviewed by Dr. K Shobana
This is a premium question & answer published on Nov 15, 2021

Hi doctor,

I got a concussion a month ago. The most painful symptoms such as head throbbing and difficulty concentrating have gone away. But still, I am experiencing some pain in the back of my head. It often occurs on the top left and right portion of the back of the head. I am taking Ibuprofen and Tylenol. My CT scan of the head and neck came back normal. I spoke with a neurologist last week and he mentioned something called occipital neuralgia. I wonder about its seriousness and treatment. Please mention whether it is long-lasting or a chronic condition or goes away in a couple of months.

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#

Hi,

Welcome to icliniq.com.

I would like to know some further details about headaches.

1. Since when you started to have these headaches? since a month after concussion only?

2. In which part of the head you had a concussion and what hit your head? how many days of concussion pain lasted? Did you became unconscious or had any seizures at the time of the concussion?

3. What kind of headaches do you feel now at the back of the head whether heaviness or bursting or squeezing or stretching or throbbing or some other kind?

4. Is your headache intermittent or persistent? if intermittent, what is the lasting duration of a single headache episode without taking pain killers?

5. Do you feel any nausea or vomiting during the headache episode?

6. Is headache associated with any redness in the eyes or watering from the eyes or nasal blockage?

7. Have you noticed any specific trigger factor or timing for this headache till now?

8. How frequent are these headaches nowadays? (how many times in a month)

9. How is the intensity of headaches whether it is mild or moderate or severe?

10. Are you taking Ibuprofen and Tylenol daily? or taking in SOS basis?

11. How is your vision of distant objects and near objects?

12. Do you have any other significant past medical history? If yes, please tell

Other information:

1. How is your sleep routine? Do you get sleepy soon after laying in bed? or it takes a long time? Once got sleepy, do you have frequent awakenings during sleep? Do you feel fresh on awakening from sleep in the morning?

2. How is your usual mood in day-to-day activities? Happy or toward the sad side (thinking about past events) or toward the worried side (thinking about future things or irritable or something else)?

3. How is your appetite?


Investigations to be done:

You need MRI (magnetic resonance imaging) brain with MRV (magnetic resonance venography).

Differential diagnosis:

You may have a post concussion headache.

Regarding follow up:

Please revert back answers for the above-mentioned questions for better understanding and further judgment.

Thank you doctor,

1. I started experiencing them a few weeks after. The pain in the back of the head remained constant and did not go away since the concussion started.

2. I hit the front right of my head. I do not have any dizziness or loss of consciousness or seizures that occurred right after or at any time. Pain is now in the top back left of my head.

3. I have a pain feeling that remains sharp or stabbing. It is like a kind of feel that it is on the outside trying to get out.

4. Headache remains persistent but varies in degree of pain throughout the day.

5. There is no nausea or vomiting.

6. There are no red eyes or nasal blockage.

7. The one thing that increases the pain is participating in zoom meetings while doing work.

8. Headache remained constant and did not stop for a full month.

9. On a pain level, it is typically around 3 or 4 out of 10.

10. I am taking Ibuprofen and Tylenol daily multiple times.

11. Vision is normal for both distances

12. There is nothing related to head trauma.

Additional:

1. I am sleeping well. I do not really wake up in the middle of the night and I typically feel refreshed in the morning.

2. During the day, I can go either way. I try to be happy and optimistic that it will go away. But when it comes back and gets worse, I will get depressed thinking that it will never go away. I am scared that this will be with me for a long time and it will affect my health in the long run.

3. Appetite is fine. I am taking food on a normal basis. I am taking healthy breakfast, lunch, and dinner.

Thank you for the detailed questions and for helping me out. I look forward to hearing from you.

#

Hi,

Welcome back to icliniq.com.

As per your description, the location of head concussion and the location of headache is totally different, so it does not seem to be trauma-related. With your description, there may be a possibility of post-concussion headache, cervicogenic headache, and tension headache. As you have already done CT (computed tomography) head and neck, which you told to be normal, may still have some findings missed in the CT (particularly in the neck region). But it can be picked in MRI (magnetic resonance imaging). Also, I would like to know whether you have any neck pain along with it. If yes, please describe its character, type, intensity, aggravating factors, and its relation to neck movements. I also suggest you quit taking analgesic tablets, as sometimes excess analgesics can aggravate the headache, causing medication overuse headache.


Investigations to be done:

You need to do MRI (magnetic resonance imaging) brain with contrast, MRI (magnetic resonance imaging) cervical spine, serum vitamin B12, serum vitamin D3, T3 (triiodothyronine), T4 (thyroxine), and TSH (thyroid-stimulating hormone).

Differential diagnosis:

You can have a post-concussion headache or cervicogenic headache or tension headache or medication overuse headache

Treatment plan:

I suggest you quit taking analgesic tablets (Ibuprofen and Tylenol), as intake of excess analgesics aggravates the headache, causing medication overuse headache.

You can try taking tricyclic antidepressants. Take tablet Amitriptyline 10 mg once at bedtime daily, after discussing with your neurologist.

MRI (magnetic resonance imaging) cervical scan will also help to look for any nerve pressure in the cervical spine, which may cause cervicogenic headache in the backside of the head. If that is found, you might require some muscle relaxants and physiotherapy in the neck region.

Preventive measures:

Along with medications, I would suggest,
1. Doing daily jogging for 20 to 30 minutes in the morning.
2. Try doing yoga and meditation daily.
3. Maintain right posture while sitting.
a) avoid prolonged forward neck flexion.
b) avoid using high and soft pillows while sleeping. If you can sleep without pillows, it will be better).

Regarding follow up:

Have a review along with your reports and further details, as needed or after two weeks.


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