From blast to bench: A translational mini‐review of posttraumatic headache

Abstract

Current events within the military and professional sports have resulted in an increased recognition of the long-term and debilitating consequences of traumatic brain injury. Mild traumatic brain injury accounts for the majority of head injuries, and post-traumatic headache is the most common adverse effect. It is estimated that between 30–90% of traumatic brain injuries result in post-traumatic headache, and for a significant number of people this headache disorder can continue for up to and over a year post-injury. Often, the most severe and chronic post-traumatic headache has a migraine-like phenotype, and is difficult to resolve. In this review we discuss the preclinical findings from animal models of post-traumatic headache. We also describe potential mechanisms by which traumatic brain injury leads to chronic post-traumatic headache, including neuroinflammatory mediators and migraine-associated neuropeptides. There are surprisingly few preclinical studies that have investigated overlapping mechanisms between post-traumatic headache and migraine, especially considering the prevalence and debilitating nature of post-traumatic headache. Given this context, post-traumatic headache is a field with many emerging opportunities for growth. The frequency of post-traumatic headache in the general and military population is staggeringly high, and further preclinical research is required to understand, ameliorate, and treat this disabling disorder.

Symptoms of Autonomic Dysfunction Among Those With Persistent Posttraumatic Headache Attributed to Mild Traumatic Brain Injury: A Comparison to Migraine and Healthy Controls

“…Investigations into mechanisms of PTH have used brain imaging, measurement of pain modulatory systems and cranial sensitization with thermal and pressure stimulation, and animal models . At present, it is unknown if PTH is a unique headache type with separate pathophysiology and clinical features from migraine and there have been few studies investigating this possibility . Investigations that deeply phenotype individuals with PTH and compare the PTH phenotype to migraine might lead to identification of features that are more representative of PTH compared to migraine.…”

“…[13][14][15] At present, it is unknown if PTH is a unique headache type with separate pathophysiology and clinical features from migraine and there have been few studies investigating this possibility. 16,17 Investigations that deeply phenotype individuals with PTH and compare the PTH phenotype to migraine might lead to identification of features that are more representative of PTH compared to migraine. Based on our clinical observations and published literature demonstrating evidence for autonomic dysfunction following mild traumatic brain injury (mTBI) and in those with migraine, we hypothesized that PTH is often accompanied by autonomic symptoms such as orthostatic intolerance, and that symptoms of autonomic dysfunction are more severe among those with PTH compared to those with migraine.…”

Emerging themes in idiopathic intracranial hypertension

“…Recent trials also demonstrate that monoclonal antibodies against CGRP or the CGRP receptor are effective for the treatment of chronic and episodic migraine [59,[70][71][72][73][74][75]. Evidence of CGRP involvement in post-traumatic headache, [76,77] which also features raised ICP, suggests that these therapeutics would also be effective for IIH headache. Furthermore, the headache phenotype in IIH is typically migraine [60].…”

Leitlinie „Begutachtung nach gedecktem Schädel-Hirntrauma im Erwachsenenalter“

“…In den letzten Jahren wurden, vor allem gestützt auf Tierversuche, andere Pathomechanismen des posttraumatischen Kopfschmerzes diskutiert. Möglicherweise spielt die Aktivierung von neuroinflammatorischen Zytokinen und migräneassoziierten Neuropeptiden eine Rolle (Moye & Pradhan 2017).…”