Narrative Review of the Pathophysiology of Headaches and Photosensitivity in Mild Traumatic Brain Injury and Concussion

Abstract

The most common symptom of post-concussive syndrome (PCS) is post-traumatic headache (PTH) accompanied by photophobia. Post-traumatic headache is currently categorized as a secondary headache disorder with a clinical phenotype described by its main features and resembling one of the primary headache disorders: tension, migraine, migraine-like cluster. Although PTH is often treated with medication used for primary headache disorders, the underlying mechanism for PTH has yet to be elucidated. The goal of this narrative literature review is to determine the current level of knowledge of these PTHs and photophobia in mild traumatic brain injury (mTBI) in order to guide further research and attempt to discover the underlying mechanism to both symptoms. The ultimate purpose is to better understand the pathophysiology of these symptoms in order to provide better and more targeted care to afflicted patients. A review of the literature was conducted using the databases CINAHL, EMBASE, PubMed. All papers were screened for sections on pathophysiology of PTH or photophobia in mTBI patients. Our paper summarizes current hypotheses. Although the exact pathophysiology of PTH and photophobia in mTBI remains to be determined, we highlight several interesting findings and avenues for future research, including central and peripheral explanations for PTH, neuroinflammation, cortical spreading depolarization and the role of glutamate excitotoxicity. We discuss the possible neuroanatomical pathways for photophobia and hypothesize a possible common pathophysiological basis between PTH and photophobia.

Exploring naturally occurring clinical subgroups of post-traumatic headache

“…According to the International Classification of Headache Disorders-3 (ICHD-3): It is defined as any headache related to a traumatic injury to the head and/or neck with headache being reported within 7 days [1]. Little is known about the pathophysiology of PTH: A number of factors have been suggested including microglial activation in the brain parenchyma, dural inflammation related to mast cell degranulation with sensitization of pain pathways, injury to the extracranial tissues and direct damage to neuronal and brain structures [4].…”

Preliminary evidence-based recommendations for return to learn: a novel pilot study tracking concussed college students

“…The use of daily phone calls, instead of online surveys, to gather comprehensive data from participants is another innovative characteristic. There are two rationales for choosing this method: to limit exposure to electronic screens, as used by other studies [32,44], given that sensitivity to light and computer screens have been known as a chief complain of concussion [43,45], and speaking to a researcher, instead of an automated system, allows participants to ask for clarification, such as confirming that sexual activity is considered physical activity. Finally, requiring a 48-h period of academic participation, following a return to baseline symptoms, allowed us to capture participants’ tolerance to a wider range of their course load.…”

Головний Біль Напруження Й Цервікогенний Головний Біль: Особливості Клінічної Картини, Діагностики Й Лікувальної Тактики

“…Цервікогенний головний біль є зазвичай однобічним, локалізується в потилиці або іррадіює ззаду на передню частину голови, може бути в ділянці обличчя, посилюється при певних рухах голови, або в певних положеннях (тривале читання), або вночі, коли голова довгий час знаходиться в незручному положенні. Цей головний біль часто супроводжується обмеженням обсягу рухів у шиї [29][30][31].…”