Posttraumatic headache

Abstract

Posttraumatic headache (PTH) is divided into acute and chronic groups whose management and prognosis are clearly different. Although IHS criteria stipulate that PTH should have an onset within 2 weeks of the trauma, it has been observed that a headache linked to the trauma can start later. PTH can be clinically divided into the following groups: migraine-like headache, tension-type-like headache, cluster-like headache, cervicogenic-like headache, and others. Based on these clinical distinctions, therapy can be administered accordingly. However, the distinction is relative and numerous clinical features may be common to all. There seems to be a weak inverse relationship between the severity of the head trauma and the occurrence of a PTH, especially chronic. A holistic approach is not only useful but it is necessary for a therapeutic success. Early and aggressive treatment and empathy are essential to the patient's improvement. Prompt recognition and treatment of laceration, peripheral nociceptive sources such as cervical joint displacement, vascular factors, may diminish chronicity. Neuromodulation of pain with prophylactic agents is recommended early. Although it is less necessary for the acute PTH, it will be crucial for the chronic form and should be initiated no later than 2 months cut-off time between acute and chronic PTH. Recognition and treatment of psychiatric factors such as depression and anxiety will lessen the risk of chronicity. Analgesic rebound-withdrawal headache commonly is seen in chronic PTH. This must be corrected rapidly because it can protract the headache and render other inappropriate therapeutic measures inefficient.

Subacute Concussion-Related Symptoms in Youth

“…30 Given that PTH and the primary headache disorders share many similar characteristics, some investigators have postulated that the migraine and PTH may have common pathophysiologic mechanisms, but the mechanisms of both syndromes remains unclear. 31,32 Women seem to be at higher risk of headache after mTBI than men, but this association was not found for younger girls (ages 6-17 years). 15,18 In another study, female sex was associated with higher number of total and somatic postconcussive symptoms 3 months after mTBI, but the authors did not mention headache specifically.…”

Posttraumatic Headache

“…2,3 According to the International Classification of Headache Disorders, 2nd edition (ICHD-2), headaches attributed to head or neck trauma include seven different secondary headache syndromes: (1) acute PTHA, (2) chronic PTHA, (3) acute headache attributed to whiplash injury, (4) chronic headache attributed to whiplash injury, (5) headache attributed to traumatic intracranial hematoma, (6) postcraniotomy headache, and (7) headache attributed to other head or neck trauma. 1 Head trauma, especially in the acute to subacute period, may result in headaches associated with a variety of structural lesions that may have serious sequelae.…”

“…5 The incidence of acute headache following mild traumatic head injury ranges from 31% to 96%. [5][6][7][8][9] Headaches occur after moderate to severe traumatic head injury in 4.3% to 37.0% of patients.…”

At the crossroads between tension-type headache and fibromyalgia

“…Just as trauma can act as an initial trigger for fibromyalgia [16], it is the initiating event in a category of tension-type headache that will be classified as a chronic post-traumatic headache [17].…”