How should I approach the management of a patient with persistent headaches following a concussion?

Approach to managing persistent headaches following a concussion:

• Recognise that persistent headaches can be part of post-concussion syndrome, which may include other symptoms such as dizziness, cognitive difficulties, and sensory sensitivities.
• Conduct a thorough clinical assessment to exclude red flags that require urgent investigation or referral, such as worsening headache with fever, new neurological deficits, cognitive dysfunction, or recent head trauma.
• Use a headache diary to document frequency, duration, severity, associated symptoms, medication use, and possible triggers over at least 8 weeks to aid diagnosis and management planning.
• Provide clear information and reassurance to the patient about the diagnosis, expected recovery trajectory, and the impact of post-concussion symptoms.
• Consider referral to a specialist experienced in traumatic brain injury management (e.g., neurologist, neuropsychologist, or multidisciplinary neurorehabilitation team) if symptoms persist or significantly impact function.
• Be alert to medication overuse headache if the patient has been using acute headache treatments frequently, and manage accordingly.
• Ensure communication with the patient’s GP and relevant community services for ongoing support and monitoring.

This approach aligns with NICE guidance on head injury assessment and headache management, emphasising careful evaluation, patient education, symptom monitoring, and specialist referral when needed ¹,².