Post-traumatic headaches: a clinical overview

Abstract

Headache attributed to head and/or neck trauma or injury, the so-called post-traumatic headache (PTH), is the most common secondary headache disorder and one of the most controversial clinical entities in the headache field, due to its unclear pathophysiological mechanisms and the unsolved role of associated psychological and medico-legal aspects. PTH, as a significant cause of morbidity after traumatic brain injury, may occur as an isolated symptom or as one of a constellation of symptoms known as post-concussive syndrome. However, in many cases, PTH might also represent an accentuation of non-disabling, remote or infrequent pre-existing primary headaches rather than a new onset headache strictly related to the trauma. Recently, the International Classification of Headache Disorders attempted to classify PTH; however, many unsolved issues are still to be clarified. In this brief review, we will focus on PTH clinical aspects and diagnostic criteria.

Acute and preventive pharmacological treatment of post-traumatic headache: a systematic review

“…Lastly , PTH patients often present with a plethora of symptoms (i.e. fatigue, depression, sleep disturbances) and not only headache [2, 22]. It would be interesting if future RCTs and high-quality open-label studies included secondary endpoints set to investigate drug efficacy on factors such as health-related quality of life, work productivity and levels of anxiety and depression.…”

Neuropsychiatric Predictors of Post‐Injury Headache After Mild‐Moderate Traumatic Brain Injury in Veterans

“…The characteristics of PTH and underlying mechanisms by which a concussive injury may lead to new or exacerbated headache are poorly understood. Headache specifically occurring or worsening immediately after TBI is often classified as a unique headache syndrome that may have a partially distinct etiology due to biomechanical forces on the musculoskeletal system and resultant neural changes occurring during or shortly after head injury . However, inconsistency of associations between headache and indicators of brain damage suggest that these mechanisms may not account for headache in all (or even most) cases .…”

“…Headache specifically occurring or worsening immediately after TBI is often classified as a unique headache syndrome that may have a partially distinct etiology due to biomechanical forces on the musculoskeletal system and resultant neural changes occurring during or shortly after head injury. 13,14 However, inconsistency of associations between headache and indicators of brain damage suggest that these mechanisms may not account for headache in all (or even most) cases. 15 For example, some studies have found a positive relationship between PTH and loss of consciousness (LOC), an index of TBI severity, 16 while other studies have shown that greater LOC is inversely associated with PTH.…”

The Role of Negative Affect on Headache‐Related Disability Following Traumatic Physical Injury

“…Rather, research has largely focused on examining predictors of post‐traumatic headache (PTH) after mild traumatic brain injury (mTBI). These studies suggest that female sex, pre‐existing psychiatric or behavioral conditions, and prior history of headache strongly predict PTH after mTBI. Additionally, postinjury PTSD contributes to chronic or worsening PTH through 1 year post‐mTBI .…”

“…Together, the psychiatric comorbidity (eg, PTSD, depression, and anxiety) associated with headache pain likely conveys amplified vulnerability to the development of health problems and impairment following injury . Byllesby et al recently noted that this comorbidity presents challenges for differential diagnosis, especially among generalized distress or negative affect‐related disorders.…”