Treatment of Headache from Head Trauma

Acute Management Algorithm

The American Academy of Pediatrics recommends nonopioid analgesics such as ibuprofen or acetaminophen as first-line treatment for headaches resulting from head trauma, with careful counseling about the risks of analgesic overuse and rebound headache 1, 2, 3
For severe or worsening headache after mild traumatic brain injury (mTBI), healthcare professionals should consider obtaining a head CT to evaluate for intracranial complications, especially when associated with other risk factors 1, 2
Children with acutely worsening headache symptoms during observation periods should undergo emergent neuroimaging 1, 2
For headaches related to remote trauma, MRI without contrast is the preferred imaging modality, particularly when neurologic signs/symptoms are present or headaches are increasing in frequency, duration, or severity 4, 5, 6

The American Academy of Pediatrics recommends providing nonopioid analgesia (ibuprofen or acetaminophen) for painful headaches after acute mTBI 1, 2, 3
Opioids should be avoided for headache management as they are not generally recommended for headache therapy 1, 2
The use of 3% hypertonic saline for treatment of acute headache after mTBI is not recommended outside of research settings 1, 2

Patients with chronic headache after mTBI should be referred for multidisciplinary evaluation and treatment 1, 2
Analgesic overuse should be considered as a potential contributory factor in chronic post-traumatic headaches 1, 2

The American Academy of Pediatrics recommends limiting the use of acute headache medications to avoid medication overuse headache, which can occur with frequent use (typically more than 2-3 days per week) 8
Healthcare professionals should be vigilant for signs of worsening that may indicate more severe injury, including severe or worsening headache 1, 2, headaches associated with vomiting 4, 5, and neurological deficits 4, 5

The American Academy of Pediatrics does not provide specific guidance on non-pharmacological approaches, however, other sources suggest encouraging adequate hydration and rest in a quiet, dark environment 7
Applying cool compresses to the forehead may provide symptomatic relief 7