Nolan McDonnell

📌 Personal Note:

This article is based on my personal experience and research.  It’s not medical advice.  Want to add your story? Email me — contact info is at the bottom.

Introduction

Headaches are one of the most common health complaints worldwide. While many people experience occasional headaches, certain populations—including individuals who have had a traumatic brain injury (TBI), a stroke, or who are aging—are at higher risk of developing persistent or recurrent headaches.

This article explains what headaches are, why they happen in these specific contexts, the types commonly seen, and evidence-based strategies to manage them.

What Are Headaches?

A headache is pain or discomfort in the head, scalp, or neck. According to the International Classification of Headache Disorders (ICHD-3), headaches can be classified as:

• Primary headaches – headaches that are not caused by another condition (e.g., migraine, tension-type headache).

• Secondary headaches – headaches caused by an underlying condition, such as injury, stroke, infection, or medication side effects. (IHS, 2018)

The pain can vary in intensity, location, and quality (e.g., throbbing, dull, sharp).

Why Do Headaches Occur After TBI, Stroke, or With Aging?

1. Headaches After Traumatic Brain Injury (TBI)

Traumatic brain injury occurs when an external force injures the brain. According to the U.S. Department of Health and Human Services and the Mayo Clinic:

• Post-traumatic headaches (PTH) are common after TBI, affecting up to 58% of people within the first year. (NIH, 2020) (Mayo Clinic, 2022)

• The exact cause isn’t always clear. Possible mechanisms include:

  • Chemical changes in the brain after injury

  • Inflammation and swelling

  • Disruption of pain pathways in the brain

  • Neck muscle strain from the injury

• PTH can resemble tension-type headaches, migraines, or other headache types.

2. Headaches After Stroke

A stroke happens when blood flow to part of the brain is blocked (ischemic stroke) or when there’s bleeding in the brain (hemorrhagic stroke). Headaches can result from:

• Acute injury to blood vessels or brain tissue

• Irritation of the brain’s pain-sensitive structures

• Changes in blood pressure or swelling around injured tissue

According to the American Stroke Association:

• About 7-34% of people experience headaches during or after a stroke, more often with hemorrhagic strokes. (American Stroke Association, 2023)

• Headaches after stroke can be sudden and severe or persistent, resembling migraines or tension-type headaches.

3. Headaches and Aging

As people age, certain changes can contribute to headaches:

• Arthritis or degenerative changes in the cervical spine (neck) may cause cervicogenic headaches.

• Blood vessel changes can influence migraine patterns.

• Use of multiple medications (polypharmacy) increases risk of medication-overuse headaches.

• Older adults may have altered pain perception, sometimes making headache symptoms less typical.

While migraines may decrease in frequency with age, some people continue to experience headaches into older adulthood. (NIH, 2023)

Types of Headaches in These Populations

Tension-Type Headache

• Mild to moderate pain, often like a tight band around the head

• Can follow TBI or occur in older adults

Migraine

• Moderate to severe pain, often throbbing

• Can involve light or sound sensitivity, nausea

• Seen in TBI survivors and post-stroke patients

Post-Traumatic Headache

• Arises within 7 days of injury (per ICHD-3 criteria)

• May mimic migraine or tension-type headache

• Can become persistent (lasting >3 months)

Cervicogenic Headache

• Originates from neck structures

• Common in older adults with neck arthritis

Medication-Overuse Headache

• Occurs from frequent pain medication use

• Seen in all groups, especially older adults

Symptoms to Watch For

Seek medical attention urgently if headaches are accompanied by:

• Sudden, severe pain (worst headache of your life)

• Weakness, numbness, difficulty speaking

• Vision changes

• Fever and stiff neck

• Nausea 

• Loss of consciousness

These can signal serious conditions requiring prompt evaluation.

Evidence-Based Treatments and Management

Treatment should be tailored by a healthcare provider, but evidence-based strategies include:

• Medication management:

  • Over-the-counter pain relievers (acetaminophen, NSAIDs) for mild pain

  • Prescription medications for migraines (e.g., triptans) under medical supervision

  • Preventive medications for frequent headaches

• Lifestyle and non-drug approaches:

  • Sleep hygiene – maintaining consistent sleep schedules

  • Hydration and nutrition

  • Physical therapy – especially for cervicogenic headaches

  • Relaxation techniques (e.g., biofeedback, mindfulness)

  • Avoiding headache triggers (e.g., certain foods, stress)

• Multidisciplinary care:

  • Neurologists, physiatrists, pain specialists, psychologists, and rehabilitation teams may be involved.

According to the American Academy of Neurology and other organizations, combining medication with behavioral strategies often yields better outcomes for chronic headaches. (AAN, 2019)

🛑 Disclaimer:

This article is for informational purposes only and does not constitute medical advice. If you have concerns about PTSD, TBI, or any other medical condition, please consult a qualified healthcare professional.

Conclusion

Headaches are common after TBI, stroke, and in older age, and they can significantly impact quality of life. Understanding the possible causes and types of headaches in these contexts is key to seeking effective care. If you or someone you care for experiences persistent or severe headaches, consult a healthcare professional for proper evaluation and personalized management.

Let’s Build This Together 💪

If you have any experience with this topic, and want to share your story, contact me!  My goal is to create a resource-rich community for survivors, caregivers, and students.

 Want to contribute?
Email me — my contact info is at the bottom of this page 

Nolan@CoachNolan.com