Persistent post-traumatic headache: a migrainous loop or not? The clinical evidence

Abstract

Background: Headache is a common complication of traumatic brain injury. The International Headache Society defines post-traumatic headache as a secondary headache attributed to trauma or injury to the head that develops within seven days following trauma. Acute post-traumatic headache resolves after 3 months, but persistent posttraumatic headache usually lasts much longer and accounts for 4% of all secondary headache disorders. Main body: The clinical features of post-traumatic headache after traumatic brain injury resemble various types of primary headaches and the most frequent are migraine-like or tension-type-like phenotypes. The neuroimaging studies that have compared persistent post-traumatic headache and migraine found different structural and functional brain changes, although migraine and post-traumatic headache may be clinically similar. Therapy of various clinical phenotypes of post-traumatic headache almost entirely mirrors the therapy of the corresponding primary headache and are currently based on expert opinion rather than scientific evidence. Pharmacologic therapies include both abortive and prophylactic agents with prophylaxis targeting comorbidities, especially impaired sleep and post-traumatic disorder. There are also effective options for non-pharmacologic therapy of posttraumatic headache, including cognitive-behavioral approaches, onabotulinum toxin injections, lifestyle considerations, etc. Conclusion: Notwithstanding some phenotypic similarities, persistent post-traumatic headache after traumatic brain injury, is considered a separate phenomenon from migraine but available data is inconclusive. High-quality studies are further required to investigate the pathophysiological mechanisms of this secondary headache, in order to identify new targets for treatment and to prevent disability.

The role of deficient pain modulatory systems in the development of persistent post-traumatic headaches following mild traumatic brain injury: an exploratory longitudinal study

“…Prospective studies of post-traumatic headaches indicate migraine followed by tension-type headaches are the most common headache types in mild TBI patients [ 5 ]. Neuroimaging and electroencephalography studies suggest different and overlapping pathophysiological mechanisms underlying migraine and PTH [ 53 ]. As in the current study, very few PTH studies investigate the possibility of differential risk factors for PTH’s of various clinical presentations (i.e., migraine vs. tension-type, vs. mixed).…”

Neurobehavioral, Cognitive, and Paroxysmal Disorders in the Long-Term Period of Pediatric Traumatic Brain Injury

“…Post-traumatic headache (PTH). Headache following traumatic brain injury (TBI) of any severity has been the most common physical symptom described and is a focus of research and clinical attention [39][40][41].…”

Position Paper on Post-Traumatic Headache: The Relationship Between Head Trauma, Stress Disorder, and Migraine

“…Indeed, a pre-existing headache disorder may be enhanced by many factors such as head traumas, stress, major depression, and PTSD [61]. Given that the most frequent pre-existing headache disorder in PTH patients is migraine, it is possible to postulate that head trauma is a trigger/worsening factor of a pre-existing headache disorder, which is daily and causes severe disability in a subgroup of patients with a pre-existing psychiatric history and other comorbidities typically associated with chronic migraine (CM) [62,63]. There is a direct link between multiple comorbidities and progression to CM with associated high levels of headache-related disability [20], suggesting a clinical overlap between PPTH and CM.…”