Often such sustained painful muscle contraction occurs without tender scars or circumscribed areas of tenderness and is associated with tension and apprehension. In some cases, these contractions represent unconscious protective immobilization of the head and neck. A third type of headache is caused by recurring episodes of distention of arterial walls. This pain is reduced by compression of the painful arteries and is eliminated by injection of ergotamine tartrate. Such pain is also associated with tension, anxiety, resentment, and fatigue.
Some patients have more than one type of headache after head injury.
Often the principal cause of the pain is outside the head. Nearly all these patients harbor resentment related to the circumstances of their accident or fear that they have sustained permanent damage to their brain. Such emotional reactions and attitudes are intimately related to the pathophysiology of the post-traumatic headache. Post-traumatic headache is usually present every day. The large majority of patients experience a dull, aching, constant, generalized discomfort, with exacerbations that may be polar, generalized, or unilateral, and usually persist for several hours.