Published November 27, 2017 By Adam Lowenstein

A traffic accident in Los Angeles?  Football injury in college?  Even the recent surge in popularity of kickboxing has produced too many head trauma patients that experience chronic migraine headaches after their injury.

I recently had an interesting conversation with a woman who had “post-concussion” headaches, but when I asked if she had isolated trauma to her head or if there was also some whiplash involved, she told me that she thought it was mostly whiplash that she had experienced.  So what kind of a headache is this?  Many head injuries have two parts- the actual hitting of the head, as well as the reaction of the neck when the head experiences the trauma. 

The brain in these cases often gets bumped around in the skull which can lead to a concussion and the associated symptoms, such as loss of consciousness, confusion, and even long-term effects that we have seen in recent reports involving the National Football League.  Primary damage to the brain can cause lasting pain and recurring headaches as well.  Immediate injuries can cause fluid accumulations or bleeding in and around the brain that can cause severe pain and even much worse.

BUT, in many cases, it is the second part of the head trauma, the neck whiplash that can be the culprit in ongoing, chronic, or recurring migraines and head pain.  Imagine what happens to the muscles of the neck when head trauma is imminent… the neck’s role in the human body is to keep the head stable.  When there is unusual motion or the body senses that there is about to be trauma to the head, the neck’s role is to tense up and try to prevent the head from hitting anything, and if it has his something, the neck is supposed to prevent the head from bouncing back or hitting something again. 

In these cases, the main stabilizing muscles of the neck become tense and strong and try to keep everything safe.  The forces of the heavy skull and brain moving in one direction while the neck is working hard to stabilize things is what creates the whiplash injury.  Duriare this situation, the tissue of the muscles- both the muscle cells themselves as well as the fascia, or connective tissue, in and around the muscles can become damaged.  This damage can come in the form of micro-stretches or even tears of the muscles or fascia tissues.

The occipital nerves run through the muscles of the neck.  From the level of the spine, the nerves course through and around several muscles including the splenius capitus, the trapezius, and the sternocleidomastoid muscles.  All of these muscles tense up in order to stabilize the head in cases of trauma.  Tightening of these muscles around the nerves is a common circumstance in head trauma, and anyone who has experienced head trauma can describe the sore muscles associated with the days or weeks following the event.  What is actually happening is the same kind of thing we see when we “pull” a muscle- stretching and tearing of the muscles tissue creates soreness, and the muscle is then repaired in time, often with some degree of scar tissue.

Athletes who experience “pulled” muscles often go through physical therapy and massage.  These therapies are meant to re-stretch the muscle tissue and loosen up scar tissue.  But do patients who have a history of “head trauma” go through the same muscle care?  Sometimes, but not often, and not often early enough to prevent chronic scarring.  The neck tissue that is stretched and torn heals with scar tissue and often creates the permanently tight tissue that can compress the nerves going through it.  Tight muscles and fascia, often associated with scar tissue and even chronic inflammation, cause compression to the occipital nerves in both the short and long-term after these head traumas.  Studies have shown that this nerve compression can often be the triggering signal that sends a distress call to the brain, triggering head pain and migraine headaches.

It is no surprise that we often see that patients with a history of head trauma have migraine headaches develop either immediately or shortly after their injury.  While a subset of these patients has primary brain issues that cause short and long-term head pain, many of these patients actually have a condition that is correctable by migraine surgery.  Nonetheless, too many patients with migraines following head trauma endure years of apparent hopelessness because they are unaware of what is truly causing their pain and that their condition is potentially curable.

How does migraine surgery relieve a post-traumatic headache?

Migraine surgery involved decompression of the nerves that send distress signals to the brain in order to trigger a migraine headache.  These nerves can be found in the forehead, the nose, the temple, and importantly for trauma patients, in the neck.  Extensive research has shown these nerves are often the critical triggers of migraine symptoms.  In post-traumatic headache patients, it is most often the occipital nerves coursing through the stabilizing neck muscles that are the culprit, as we have discussed.  Migraine surgery in these cases is meant to decompress some or all of these nerves and has a greater than 90% success rate in improving post-traumatic headaches in appropriate candidates.

The nerves involved in post-traumatic headaches are often the greater occipital, lesser occipital, and third occipital nerves.  All three of these nerves can be addressed in migraine surgery to decompress them and create a more relaxed state so the distress signal that causes migraine symptoms is no longer triggered.  This can prevent auras, nausea, light sensitivity, and the pain associated with post-traumatic headaches.  By releasing the nerves from the scar tissue and inflamed tissue surrounding them, the damage caused by the initial stretching, tearing, and “pulling” of these muscles can be reversed, and the nerves are then protected from these constricting forces.  Nerves that no longer have compression and inflammation surrounding them can work normally instead of creating distress signals.  Without the distress signals, the brain is free to work normally as well… no pain, no auras, no symptoms.

Following migraine surgery, post-traumatic headache patients can return to a normal life, one many of these patients have not known for too many years.  After being told that nothing could be done to help them for so long, these patients are often the most grateful for finding relief of their chronic headache symptoms.

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