Pathogenesis of Posttraumatic Headache and Migraine: A Common Headache Pathway?

Packard, Russell C.; Ham, Lesley P.

doi:10.1046/j.1526-4610.1997.3703142.x

Cited by 98 publications

(80 citation statements)

References 72 publications

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“…In previous research, microscopic lesions detectable by nuclear medicine techniques have been found in the frontal cortex in mild to moderate head trauma or whiplash [4,17]. Such lesions may establish the basis for a biochemical cascade in brain tissue that is similar to events said to occur in migraine, and may help to explain migraine as a result of cranio-cervical acceleration/deceleration trauma [24]. Furthermore, about 20% of the present sample suffered from what is referred to as cervicogenic headache [15].…”

Section: Headache Typementioning

confidence: 95%

Symptomatic approach to posttraumatic headache and its possible implications for treatment

2001

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We investigated 112 patients [mean age 39.5 +/- 10.5 years, 59% women (n=66)] with chronic posttraumatic headache following cranio-cervical acceleration/deceleration trauma after an average time interval of 2.5 +/- 1.9 years from trauma. Headache following minor head injury or whiplash is one of the most prominent problems in neurotraumatology. Previous research is inconclusive regarding the symptomatic approach of this type of headache. Details of the phenomenology of posttraumatic headache in the previous literature are inconclusive. This may lead to inappropriate treatment strategies, because recent advances in therapy of different headache types may be neglected. Patients were investigated at the outpatient service of the Department of Psychiatry. Headache was analyzed according to its principal location, laterality, projection, quality, precipitation or aggravation and possible additional symptoms. For this analysis, headache was diagnosed according to the classification of the International Headache Society. The results showed that 42 patients (37%) had tension-type headache, 30 (27%) were identified as suffering from migraine, whereas 20 patients (18%) had cervicogenic headache. An additional 18% of patients suffered from headache that did not fulfill criteria of a particular category. In 104 patients (93%), neck pain was associated in time with headache. Each of the diagnosed headache types in this study may require specific treatment strategies based upon empirical studies of non-traumatic headache types. For these reasons a detailed analysis of headache following cranio-cervical acceleration/deceleration trauma is necessary.

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Section: Headache Typementioning

confidence: 95%

Symptomatic approach to posttraumatic headache and its possible implications for treatment

2001

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“…It is uncertain if the trigeminal nociceptive system is related to trigeminal-vascular pathways involved in the pathogenesis of migraine, but it is possible [8]. WI can occasionally precipitate migraine headache attacks [31].…”

Section: Trigeminal Nociceptive System and Occipital Nervesmentioning

confidence: 99%

“…Twelve weeks after the injury, post-traumatic headache (PTHA) will still be present in up to 73% of patients [6]. PTHAs may be caused by several different mechanisms, including direct contact injury, indirect or nonimpact injury (WI), direct soft tissue injuries, altered cerebral hemodynamics [7], or by a poorly understood cascade of metabolic changes occurring in the injured brain [8]. Realizing the most common "cause" of PTHA may be the overlapping of several of these mechanisms, this paper will primarily explore the relationship of neck injury (WI) to PTHA.…”

Section: Introductionmentioning

confidence: 99%

The relationship of neck injury and post-traumatic headache

Packard

2002

Current Science Inc

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Although there may be several causes of post-traumatic headache, neck injury is perhaps the most common. This paper primarily reviews the relationship of neck injury, whiplash, and post-traumatic headache. Mechanisms may include structural damage from acceleration or extension of the neck, development of myofascial pain and trigger points, interaction of the trigeminal nociceptive system with the upper cervical (occipital) nerves, and psychologic and emotional factors. Although some healing will occur, the outcome may depend on a number of human factors (awareness of an impending collision) and the fact that repaired tissue is different from normal, uninjured tissue.

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“…Stimulation of the trigeminal nerves results in the release of inflammatory chemicals, which in turn produces further meningeal artery dilation and also activation of the pain generator in the lower brainstem and upper cervical cord. This trigeminal-vascular system may be activated, injured, or disturbed by nonpenetrating (and particularly mild) traumatic brain injury (TBI), and in so doing could set off the migraine headache pathways [3].…”

Section: Introductionmentioning

confidence: 99%

“…Increased or ongoing stimulation of the pain generator from the cervical cord may result in the development of migraine-type headaches. Packard and Ham [3] suggested that there is substantial similarity between the chemical activation associated with spontaneous migraines and that produced by TBI. In both migraine and mild head injury, dysfunction or dysregulation of the trigeminal-vascular system appears to activate a "common headache pathway.…”

Section: Introductionmentioning

confidence: 99%

Post-traumatic headache

Lane¹,

Arciniegas²

2002

Curr Treat Options Neurol

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Headache is the most common symptom after closed head injury, persisting for more than 2 months in 60% of patients. Rarely does headache occur in isolation. Cervical pain is a frequent accompaniment. Post-traumatic headache is often one of several symptoms of the postconcussive syndrome, and therefore may be accompanied by additional cognitive, behavioral, and somatic problems. Acute post-traumatic headaches may begin at the time of injury and continue for up to 2 months post-injury. Although onset proximate to the time of injury is most common, any new headache type occurring within this period of time is referred to as an acute post-traumatic headache. If such headaches persist beyond the first two months post-injury, they are subsequently referred to as chronic post-traumatic headaches. Over time, post-traumatic headaches may take on a pattern of daily occurrence. If aggressive treatment is initiated early, posttraumatic headache is less likely to become a permanent problem. Once "windup" of post-traumatic headaches occurs, the cycle of ongoing headaches is more difficult to interrupt. The mechanism of post-traumatic headache is poorly understood. Trauma-induced headaches are usually heterogeneous in nature, often including both tension-type pain and intermittent migraine-like attacks. Rebound-headaches may develop from overuse of analgesic medications, and the occurrence of such may complicate significantly the diagnosis of post-traumatic headache. Adequate treatment typically requires both "peripheral" and "central" measures. Understanding the general principles of treatment, especially appropriate use of preventive and abortive medications, will most usefully guide treatment. There is scant literature with which to direct treatment selection for post-traumatic headache. Consequently, treatments for post-traumatic headache are based on those prescribed for phenomenologically similar but etiologically distinct headache disorders. Delayed recovery from post-traumatic headache may be a result of inadequately aggressive or ineffective treatment, overuse of analgesic medications resulting in analgesia rebound phenomena, or comorbid psychiatric disorders (eg, post-traumatic stress disorder, insomnia, substance abuse, depression, or anxiety).

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Pathogenesis of Posttraumatic Headache and Migraine: A Common Headache Pathway?

Cited by 98 publications

References 72 publications

Symptomatic approach to posttraumatic headache and its possible implications for treatment

Symptomatic approach to posttraumatic headache and its possible implications for treatment

The relationship of neck injury and post-traumatic headache

Post-traumatic headache

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