Post-traumatic headache

Abstract

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).

Part I—Evaluation of Pediatric Post-traumatic Headaches

“…47 Medication overuse headache is thought to be a complex phenomenon reflecting dysregulation of serotonergic and opiate systems because of chronic overuse of symptomatic headache therapies. 42 Typically, the headache worsens for 2 weeks after analgesic cessation, but the headache usually, but not invariably, resolves after the overused medication is stopped. 24 Not all medications have the same potential to lead to medication overuse headache.…”

“…49 Comorbid medical or neuropsychiatric conditions should be treated aggressively to reduce the likelihood of delayed recovery from PTHA or from the postconcussive syndrome. 42 Children and adolescents generally take longer to recover from concussions 51,52 ; thus, evaluation of cognition and possible psychological factors is particularly important in pediatric PTHA.…”

Neuropsychologic aspects of post-traumatic headache and chronic daily headache

“…It lasts longer than 2 months in 60% of the cases, is often accompanied by cervical pain, and almost always is accompanied by PCS [10,11].…”

“…The importance of starting intervention early has been emphasized; once the chronic cycle has started, it is harder to interrupt. Poor outcome may be a factor of not intervening quickly enough, leading to medication overuse or psychiatric comorbidity [10]. Saper et al [5] and other researchers have reported that chronic head pain often involves medication overuse.…”

Posttraumatic headache

“…Early and sustained management and sympathetic attitude from the physician also is beneficial. It is crucial to avoid a central sensitization during which second and third order neurons will remain independently active and cause a protracted headache course [54,55]. It is crucial to work on early socioprofessional reinsertion.…”