A 28-year-old pregnant woman (2nd trimester) sustained cerebral concussions due to a road traffic accident, having no external injury; CT - unremarkable. But, feeling intolerable headache & sleeplessness, may be due to PTSD in addition. Because, she lost her husband in the same incident, but not yet informed. At this moment, what could be the most effective+suitable analgesics for her?
The pain may be neurogenic, psychological or could be somatic given that she had an accident with head injury with certain anxiety about immediate family and possibly for unborn baby. Antidepressant with serotonin and noradrenaline reuptake inhibitor activity like venlafaxine or duloxetine would address all possibly implicated causes/ reasons for her headache and are even safe in pregnancy which even though is not a major concern given fact that she is in second trimester of her pregnancy.
I would first check her shoulder and neck muscles, you may find trigger points (TrP) there. In this case, specific management of TrP by a trained physiotherapist would be nice. You may also use Trans Electrical Nerve Stimulation on shoulders.
Last but very important, I would use Ericksonian Hypnotherapy and/or EMDR for anxiety/PTSD.
ATD medication may be used but stopped as soon as possible.
Consider Neurofeedback (if you can find a practitioner) for both HA and cognitive dysfunctions. Alpha/Theta neurofeedback also has remarkable impact on PTSD.
I used this uniquely useful tool with several hundred active duty soldiers with TBI & PTSD, with 80% having co-morbid concussion-related headaches. Worked very well for HA and TBI cognitive slowing and memory issues. I did not usually have enough sessions for the PTSD effects. I used the EEG Info Cygnet system and treatment protocols. . Also this approach has the advantage of not being pharmacology.
It seems rather probable that these headaches could be due to a whiplash injury suffered by the accident, leading to a functional disorder of the neck muscles and secondary to those headaches as obviously Philippe Rault assumed already.
Try the very simple, nontoxic and undangerous treatment as described in > Cervical Vertigo - Cervical Pain < full text under my name in Research Gate.
In addition You could supplement this therapy with dropplets od local anaesthetics (instead of Meaverin You could use any other in lowest concentration f.i. Lidocain) given by injection with a very thin needel to the cranial periost (bony resistance) along the gallbladder meridian starting with the occipital location as described and ending in the frontal position described for the accupuncture in the publication above and inbetween adding 2 or 3 further injections on the side of the skull involved.
Three acupuncture points will dissipate the headache within minutes after puncturing. SP 1, LR 1 and KI 1. If the headache is mostly one sided, the contra-lateral foot should be punctured.
The pleasure is all mine. Did you try it? Also, if necessary, I can suggest a PTSD treatment for her, which will undoubtedly improve a couple more things.
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