Post Traumatic and other Headache Syndromes. Danielle L. Erb, MD Brain Rehabilitation Medicine, LLC Brain Injury Rehab Center, PRA

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1 Post Traumatic and other Headache Syndromes Danielle L. Erb, MD Brain Rehabilitation Medicine, LLC Brain Injury Rehab Center, PRA

2 Over 45 million Americans have chronic, recurring headaches 62% of these people have migraine headaches 30% of TBI survivors have chronic headaches

3 Common Types of Headaches Migraine Pain on one side of the head, nausea and altered vision Tension Pain experienced as a squeezing band around the head Sinus Pain behind forehead and/or cheekbones Cluster Pain localized in one eye

4

5 Most headaches are caused by muscle contraction or blood flow problems

6 Common types of headaches after TBI: Migraine Tension type most common type Occipital neuralgia Temporomandibular joint disorders (TMJD) Cervicogenic (neck) Rebound Autonomic headaches (includes cluster headaches)

7 Migraine headaches Usually one side of head Light and/or sound sensitivity Pain level: moderate to severe Nausea and sometimes vomiting Dull, throbbing sensation Warning signal or aura Family history is common

8 Mechanism of Migraine HA Pain

9 Migraine triggers

10 Migraine triggers

11

12 Migraine headache food triggers

13 Migraine Medications Abortive Can only be used 2 times per week Find the drug that works the fastest for you Dr. Erb s fire theory Preventative If headaches are frequent, more than 9 10/month then need to use daily medication

14 Migraine Medications Abortive Aspirin NSAIDS (Motrin, Aleve, etc) Midrin Triptans

15 Migraine Medications Preventative Beta blockers Calcium channel blockers Tricyclics Anticonvulsants Feverfew Butterbur Magnesium with riboflavin Botox

16 Migraine prevention with herbal medications Riboflavin (Vitamin B2): 400mg per day Magnesium: mg, 2 times/day magnesium citrate is better absorbed than oxide Butterbur: 50mg 3 times/day may also help at onset of migraine Feverfew leaf extract: mg per day reliable brand Nature s Way

17 Tension type headaches

18 Muscle tension in the face, neck and shoulders may cause tension headache

19 Tension type headaches Tight, squeezing sensation; often around the entire head or on both sides Pain level: mild to moderate Often occur later in the day

20 Cycle of pain

21 Deep Muscles Neck and Upper Back

22 Stressors

23 Cervicogenic headaches Pain starts in neck, shoulders or back of head, and sometimes travels over top of the head Neck movement, or changing positions can change the headache Pain level: mild to severe

24 Possible areas of pain: upper back and neck base of the head the ears above the ears the jaw above the eyes

25 Rebound headaches Other names: medication overuse headaches, drug induced headaches and analgesic rebound headaches >15 headache days/month Use of acute meds more than 15 times/month for at least 3 months 50 86% of chronic daily headaches are rebound headaches

26 Rebound headaches Daily or near daily headache Timing predictable, frequently early morning (2 5am) Varies in severity, location and type of pain Low pain threshold with physical or cognitive exertion Associated with nausea, GI symptoms, anxiety, restlessness, irritability, cognitive changes, cold and/or weak extremities, rapid pulse, high blood pressure

27 Cluster Headaches Cluster headaches may involve pain around one eye, along with drooping of the lid, tearing and congestion on the same side as the pain

28

29 Headache treatments Patient education Participate in your own care Identify and control or remove triggers Start a wellness program exercise, adequate and regular sleep, healthy diet, stop smoking Medication treatments Physical treatments Behavioral and psychological therapies

30 Headache treatments

31 Headache treatments

32 Headache treatments

33 Headache treatments?

34 Headache treatments

35 Biofeedback therapy

36 Headache treatments

37 Headache treatments

38 Headache treatments

39 Headache treatments

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