200 Section - Post-Traumatic Headache Managed with Low-Cost Interventions in a Trauma Rehabilitation Clinic: A Case Report Demonstrating the Value of Cross-Specialty Training in a Major Trauma Centre

Wednesday, May 20, 2026

6:00 PM - 7:30 PM PT

Presenting Author/Autor expositor(s)

AM

Aoife Murray, MD

Specialist Registrar
Oxford Centre for Enablement, Oxford University Hospital Trust
Galway, Galway, Ireland

Co-Author/Coautor(s)

AR

Ailbhe Raftery, MD

Specialist Registrar
Cork University Hospital
Cork, Cork, Ireland
RC

Ruairi Connolly, MD

Consultant in Trauma Rehabilitation Medicine
Cork University Hospital
Cork, Cork, Ireland

Case Diagnosis:

A 73-year-old previously fit farmer sustained a moderate-to-severe traumatic brain injury(TBI) after being knocked down by a cow. Initial imaging demonstrated right parieto-occipital soft tissue swelling and a contre-coup posterior left temporal haemorrhagic contusion with small volume extra-axial subacute blood products. He was observed for 24 hours and discharged home with a GCS of 15/15 and persistent headache.

Case Description:

He was reviewed at the Trauma Neuro-Rehabilitation Clinic after attempting a full return to his usual activities, which resulted in persistent occipital and neck pain, refractory headaches, vestibular signs and symptoms, and cognitive fatigue.

A structured return-to-work plan was instituted focusing on fatigue and pain management, along with referral for vestibular rehabilitation. Follow-up was arranged every two weeks, combining in-person reviews with interim phone calls.

The treating PRM physician, equipped with cross-specialty procedural training, performed occipital nerve blocks and targeted trigger point injections. These interventions led to complete resolution of headache and neck pain, improved tolerance for vestibular rehabilitation, reduction in RPQ symptoms, and full return to work at 14 weeks post-injury. No onward referrals were required.

Discussions:

Post-traumatic headache is a frequent and challenging complication of TBI that can significantly affect recovery, participation, and quality of life. Effective management often requires a multimodal approach. This case demonstrates how cross-specialty training can equip PRM physicians with procedural skills allowing for low-cost, effective symptom management without referral to other specialties.

Conclusions:

This case underscores the value of embedding procedural competencies—such as occipital nerve blocks and trigger point injections—into PRM training programmes, particularly in countries where the specialty is still maturing. Cross-specialty skill acquisition enhances patient outcomes, reduces referral burden, expands the therapeutic toolkit, and improves continuity of care.