Migraine vs. Post-Concussive Syndrome: Presentation and Pathophysiology

Presentation Patients experiencing migraines typically report intense throbbing pain or a pulsating sensation, often localized to one side of the head. Common symptoms accompanying migraines include nausea, vomiting, and heightened sensitivity to light and sound (Schub & Parks-Chapman, 2018). On the other hand, patients with post-concussive syndrome (PCS) usually present symptoms 3-10 days after sustaining a traumatic brain injury. These symptoms include headaches, fatigue, vertigo, nausea, vomiting, sensitivity to light and sound, visual disturbances, and abnormal sleep patterns. Cognitive difficulties, such as problems with concentration, attention, and memory, are also commonly observed. In some cases, emotional instability and anxiety may be present (March & Karakashian, 2018).

Pathophysiology The pathophysiology of migraines was traditionally believed to be related to vascular dysregulation. However, recent research has challenged this view. Current understanding suggests that migraines are not caused by vasodilation and vasoconstriction of the brain’s blood vessels, but rather by neuronal sensitization. This heightened sensitivity of neurons results in the characteristic pain and pressure associated with migraines (Charles, 2018).

In contrast, the pathophysiology of post-concussive syndrome is attributed to an immune-inflammatory response triggered by the initial injury. This response, known as immunoexcitotoxicity, leads to an excess of glutamate, which disrupts the regulation of calcium into the brain’s neurons. The accumulation of calcium causes cellular damage, contributing to the symptoms of PCS.