POST TRAUMATIC HEADACHESJust a few days ago, I read an Instagram post that discussed post-traumatic headaches. There was a description of someone who had suffered a head injury following an assault and suffered a skull fracture that healed without surgery. This person subsequently began to experience headaches that were unremitting. The MRIs of the brain and neck did not identify any pathology and the patient had failed physical therapy and massage treatments. He was diagnosed as having a concussion and treated accordingly, but the headaches persisted.

The remainder of the post went on to detail how, over the ensuing years, he was presumed to have developed ‘migraines’ and tried on various medications, all unsuccessful. There were descriptions of altered brain activity, presumed (but never identified) problems with the blood vessels in the brain and various suspected chemical abnormalities (hence all the drugs). During this entire time, the patient was complaining of consistent pain in a specific area of the head/scalp.

Unfortunately, this story resonated with me because it sounded all too familiar. The remarkable thing for me was that no time during the entire saga did anyone even entertain the possibility that there might be a peripheral nerve in the scalp that had been injured with the fracture and subsequent scarring that occurred. It struck me as odd that if the same thing had happened in the forearm with an ulnar bone fracture and the patient began to experience hand pain in the small finger, the concept of a nerve injury would be at the top of the possible causes. The fact of the matter is that this person might just have an entrapped peripheral nerve in the scalp that is causing the pain.

I wanted to reach into the phone and suggest to this patient that he consider this possibility.  He should have a nerve block and if, successful, perhaps an outpatient procedure might just fix the issue permanently.  This whole scenario also got me thinking about why people don’t consider the peripheral nervous system in these cases. I think there are many explanations for that observation. More about that topic in an upcoming post.

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