Post-concussion headache treatments

[Stephanie C]

I have had a post-concussion tensio-type chronic headache for 3.5 years (caused by a vehicle rollover).

For the past 2 years I have been receiving Botox injections every 3 months and they give me almost 3 months of being almost headache-free. However, there is a 3-4 week period when the previous Botox injections wear off and before the latest injections start working (they take about 2 wks to work for me) when my headache is back and it's exhausting and unbearable. I still take 30 mg nortriptyline on a daily basis (amitriptyline made me too tired to function properly) and I've tried countless painkillers and migraine drugs (incl. Imitrex,  oxycocet, percocet, tylenol 3, naprosyn etc) which do little to take the edge off the headache and make me even more tired. I also go for massages and do yoga. Is there anything else you can recommend?

I'm exhausted and am in trouble at work for having so many sick days. My neurologist said my headache may never go away, but doesn't have any other suggestions as to what I can do to improve my quality of life. I don't want to be on botox for the rest of my life and even if I am, I really need something for those in-between times.
Thanks,
Stephanie

[CCF-Neuro-M.D.-CS]

I know that you have seen a neurologist for this problem, but with a complex headache such as yours I would recommend that you be seen at an academic headache center. There are several well known centers around the U.S., and we have a wonderful center here at the Cleveland Clinic. That being said there are many other treatment options available.

Regarding treatment there are agents which are prescribed in an attempt to prevent headaches and medication designed to abort a headache once it has started.

Preventives include: anti-seizure medications such as Depakote or Topamax, cardiac medications such as beta blcokers or verapamil, and anti-depressive medications such as nortriptyline.

Abortive agents include: The class of medications called the "triptans" such as Imitrex. If you fail one particular drug in this class you should try a few others before stating they do not work. Other over the counter agents such as Tylenol, Ibuprofen, or Aleve. Also some patients receive benefits from anti-cholinergics such as benadryl, and even low doses of anti-psychotic medications.

If oral medication fails there are also intravenous infusions which may help some people.

So as you can see there are many options available, and by seeing a headache doctor at a headache center you can begin to work through these options and hopefully find the one which is right for you. Good luck.

[Stephanie C]

Thanks for your response. I will look into some of these other options. No one has ever explained the various classes of drugs to me before, so that was very helpful. Thanks!

[johnny O]

I suffered a severe concussion on this past December 2.  I now get headaches pretty much daily, not sharp or severe headaches, but more dull (still painful and draining though).  Also, my eyes are much more sensitive to light now, but not to a debilitating degree.  Two days after i recieved the concussion i got a cat scan in the emergency room (two days later was when I first went to the hospital) and the doc said my brain was fine.  Should I be worried at this point, with the headaches and sensitivity to light?  Should I go and see a doctor about this?  Everything I have read so far tells me that doctors cant really understand or predict the post-concussion effects, I hope this is not true!