Post-Concussive Syndrome: a Focus on Post-Traumatic Headache and Related Cognitive, Psychiatric, and Sleep Issues

Abstract

Up to one third of PTH patients may have depression and about one quarter may have insomnia. Anxiety and cognitive issues are also common. While there are few studies examining abortive medications for PTH, recent studies of preventive medications examine the efficacy of topiramate, and topiramate may be better than other oral preventive medications. Other currently investigated treatments include nerve blocks, onabotulinum toxin A, transmagnetic stimulation, and behavioral therapy (biofeedback). Due to an expanded focus on and knowledge of concussion and PTH, comorbid psychiatric, cognitive, and sleep issues have become more widely acknowledged and studied. However, more high-quality studies must be conducted to examine the underlying pathophysiology of PTH and associated symptoms and to determine the most effective abortive and preventive treatment options.

A review of sleep disturbances following traumatic brain injury

“…This symptom can have a significant impact on quality of life both during wakefulness and sleep and can be seen irrespective of the severity of the injury. Multiple studies have been performed to evaluate the impact of post-traumatic headache (PTH) on sleep, with insomnia the most common symptom experienced (Minen et al 2016;Hou et al 2013). A retrospective cohort study (n = 98) showed that headache and insomnia are frequently comorbid conditions in the mild TBI population, with up to half of patients with PTH also suffering from insomnia (Hou et al 2013).…”

“…Mood disturbances following TBI are also common, with estimates of prevalence of depression from 20 to 46% and anxiety from 24 to 61% (n = 443) (Chaput et al 2009;Minen et al 2016;Jaramillo et al 2016). Depression and anxiety are often comorbid with PTH following TBI, with up to 33% of patients with TBI suffering from a mood disturbance and PTH (Minen et al 2016).…”

“…Depression and anxiety are often comorbid with PTH following TBI, with up to 33% of patients with TBI suffering from a mood disturbance and PTH (Minen et al 2016). In addition, one study of 150 subjects and another of 168 subjects demonstrated that patients with TBI previously who suffered a repeat TBI were at higher risk for development of depression than those without previous TBI (Bryan 2013;Holster et al 2017).…”

“…Furthermore, central nervous system symptoms occurring as a result of TBI also may cause disruption of sleep (Pillar et al 2003;Lavigne et al 2015;Chaput et al 2009;Minen et al 2016;Hou et al 2013;Jaramillo et al 2016;Farrell-Carnahan et al 2015;Bryan 2013;Holster et al 2017). These include headache, tinnitus and/or vertigo.…”

“…These include headache, tinnitus and/or vertigo. Mood disorders such as anxiety or depression that result from TBI are also common and may have a negative impact on sleep (Pillar et al 2003;Chaput et al 2009;Minen et al 2016;Farrell-Carnahan et al 2015;Bryan 2013;Holster et al 2017). Sleep disturbances in the chronic phase are varied and include insomnia as well as circadian rhythm disruption (Wickwire et al 2016;Mathias and Alvaro 2012;Nakase-Richardson et al 2013;Chan and Feinstein 2015;Pillar et al 2003).…”