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Is it post concussion syndrome (PCS) or post-traumatic migraines?
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Is it post concussion syndrome (PCS) or post-traumatic migraines?

Two months ago, I was involved in a car accident where I hit my head twice. I has a headache afterwards and some neck pain but no other symptoms. About six weeks after the accident, I started to develop really bad headaches at the top of my head, nausea, dizziness, blurry vision and sensitivity to light (to the point of wearing sunglasses indoors!) My physiotherapist was convinced that I have post concussion syndrome so I went to see a neurologist, but he said that it can’t be PCS because the symptoms didn’t occur until 6 weeks later. He told me I have chronic migraines (my symptoms have lasted about a month straight now) and told me to avoid some common triggers and see if it gets better. He also told me that it’s okay for me to exercise, but my physiotherapist says not to do anything but rest. I don’t know who is correct here, and whether it is safe for me to workout. I feel light-headed and like I want to vomit almost all the time. I have not had an MRI done. What should I do? The neurologist told me he doesn’t have to see me again since he doesn’t think there is a brain injury. But my symptoms are daily and not going away and it has now been 2 months since the accident
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Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to obtain a history from you and examine you, I cannot comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter.

Headache is a common result of head injury and it might persist for months or years following even mild head trauma.  A variety of headache subtypes can be precipitated by head trauma, although posttraumatic headaches most often resemble migraine or tension-type headache.  Post traumatic headaches  must begin within 7 days after head trauma or after regaining consciousness. New headaches that develop beyond 7 days after the injury are not classified as PTHAs. Acute PTHAs begin within 7 days of head trauma and may continue for up to 3 months after the injury. PTHAs that persist beyond 3 months after the inciting head trauma are classified as chronic. PTHAs are further classified according to the severity of head trauma.  Post traumatic headaches, especially those possessing migraine features, may share the same pathophysiology as migraines, which is why you may have symptoms that resemble migraines.  
Head CT or MRI has been recommended in patients whose headaches worsen or persist longer than one week after concussion.
The treatment of PTHAs can be both challenging. Since they are similar to migraines, we attempt to treat them with migraine medications, therefore would recommend speaking to your neurologist regarding this.  

I hope this information was helpful. Good luck.  
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