An Injury Sooner Forgotten
August 4, 2010 4:15 PM   Subscribe

What could be the physiology involved in mild headaches weeks after head injury?

I know you're not my doctor, and I don't want medical advice as much as physiological information.

About two months ago I suffered a fall from the third step of our apartment exit. Most of my weight landed on my arm, fractured in two places. I also landed slightly on my head on the travertine floor, with a mark coincidentally centered directly over an osteoma. The mark just barely broke the skin and I had a minor headache. I threw up in the car about thirty minutes later on the way to immediate care and, because the CT scan there had just closed for the day we ended up in an ER. The physician there did not think a CT was necessary. I'd not lost consciousness, pupils and cognition were fine, I just had this mild headache that's identical to one I get now, about every other day. I believe I got sick just from the stress of the fall, with a bit of undigested food eaten moments before the fall. I've already had three CT scans of my head in the past three years(toward diagnosing left-sided trigeminal neuralgia) and appreciated the physician's judgment in avoiding more radiation.

The headaches stand out because their identical to the one right after the accident and because they're unlike any I've had before. I never had them on the right side, or with a feeling of being like a lightening-bolts of pressure within the upper right quadrant of my head, not really the skull. They're not like tension headaches or migraines. I've had no other odd symptoms since the accident.

I'm not really worried about this, just want to be able to visualize what might be going on physiologically. What tissues or processes could get injured in there? I'm interested in how the body works and like to visualize processes in detail. I'd be especially grateful for any insights there.
posted by Mertonian to Health & Fitness (7 answers total) 1 user marked this as a favorite
Wild stab in the dark... Are you on any new meds? Look at the side effects.
posted by WhiteWhale at 4:33 PM on August 4, 2010

Best answer: Sounds like Post-concussion syndrome. The doctor was probably right, a head CT is unlikely to be sensitive enough to inform what's going on inside your head, although the vomiting is a bit of a worry, and an indicator of the possibility of a significant physical injury. Follow up with your family doctor until the symptoms subside. You may also want a referral to a neuropsychologist or neurologist (more likely the former). In fact, if your PCS symptoms are persisting after two months, this is probably a good idea.

(disclaimer: I am not a medical doctor, but did write a thesis looking at PCS symptoms in sever head injury survivors many years ago - I no longer work in the area).
posted by singingfish at 4:34 PM on August 4, 2010 [1 favorite]

err, ... a significant physical injury that's reasonably likely to be transient in nature.
posted by singingfish at 4:35 PM on August 4, 2010

IANAD. While it's good that you're not worried, the vomiting immediately after your fall, and the persistence of these headaches, does seem to warrant following up with your physician.
posted by NucleophilicAttack at 4:44 PM on August 4, 2010

Best answer: PCS could fit very well. So could many other things. Please do follow-up with a physician, and ask for a referral to a neurologist. I've already shared my story of 'Epilepsy? Haha, that's for losers!' on another thread this month, but I'll share it again anyway.

The moral of the story isn't 'OMG, U PROBLY HAVE EPILEPSY.' The moral here is: 'if it's something that could possibly involve your brain, you need to see someone soonerish rather than laterish, because that is the most complicated and important structure in your body, and nature surrounded it with a big ol' collection of pointy objects that it decided to put on the inside.' (See: the back of the human skull for an example of really poor placement of incredibly sharp and hard edges.)

From a purely anatomical point of view: the brain could have sustained microtears; one or more cranial nerves could have sustained microtears; either could have sustained bruising; the vasculature could be a bit jacked up and have little clots or bleeds. Maybe the dura mater (the toughest of the meningeal layers) got a bit damaged, maybe there's some irritation of the periosteum in the calvarium (the part of your skull that surrounds the brain), or the bone, or the periosteum on the outside of the skull. Maybe CSF drainage is transiently occluded.

I can come up with hideous-sounding maybes with varying degrees of probability all night. Probably it is none of these things that I suggested. My point is that headaches are nonspecific, and the brain is complicated, so those two things plus head bump, plus duration of the symptoms=physician definitely, neurologist if you can get one or a referral.
posted by Uniformitarianism Now! at 6:08 PM on August 4, 2010 [1 favorite]

Best answer: Injury causes swelling. There's not much room for anything to swell inside the skull, and although brain tissue itself isn't sensitive to pain, the stuff around it is. See a neurologist-- you don't want to mess around as people have said above.
posted by Maias at 6:46 PM on August 4, 2010

Response by poster: Okay. I'll call tomorrow. Naturally I'd pick the week that most docs are on vacation. Thanks everyone!
posted by Mertonian at 8:36 PM on August 4, 2010

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