Acute TBI/ Migraine

The collection of sounds being too loud (hyperacusis), light being too strong (photophobia) is commonly seen in post-concussive syndrome, but is shared in migraine headaches and, in my clinical experience, is also common in patients with Borderline Personality Disorder. Patients with autism spectrum disorder have a similar symptom subset often referred to as sensory overload. IMG

These symptoms often evolve into more severe pain as time since onset increases. IMG

For several decades now, the bulk of migraine treatment has consisted of triptan acute therapy in addition to prophylactic measures including propranolol and topiramate. Venlafaxine, chemically similar to triptans, also shows benefit in migraine prevention PMID 30895388. IMG

Amitriptyline has shown promise in treatment of post-concussive syndrome PMID 31943197.  IMG

In my clinical experience, patients who punch themselves in the head (different than headbanging behavior associated with BPD/autism) often show other signs of increased cortisol/IMP excess. It may be that head-injury induces a shunt from inosine to hypoxanthine that acutely eases the IMP excess. IMG