Current Pain and Headache Reports

, Volume 9, Issue 1, pp 59–64 | Cite as

Current concepts in chronic post-traumatic headache

  • Russell C. Packard
Article

Abstract

Over the years, there has been much confusion and conflict regarding when a post-traumatic headache (PTH) should be classified as chronic. Chronic pain usually is described as pain persisting for longer than 6 months. For many years, a chronic PTH was considered to be a headache lasting longer than 2 months. Some useful definitions and criteria were published in 2003 by the International Headache Society, in the Second Edition of the Classification and Diagnostic Criteria for Headache Disorders. These criteria are reviewed and discussion follows regarding the problem of when a chronic PTH should be classified as permanent. This becomes very important in a medical-legal context. Management of chronic PTH often will require a multifactorial approach.

Keywords

Migraine Head Injury Head Trauma Headache Disorder Chronic Daily Headache 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    International Headache Society: International classification of headache disorders, edn 2. Released October 1, 2003, 56–62. www.i-h-s.org. Accessed June 8, 2004. This entire updated classification of headache disorders is the generally accepted standard. It should be reviewed by anyone doing headache research or interested in current criteria for diagnosis.Google Scholar
  2. 2.
    Brenner C, Friedman AP, Merritt HH, et al.: Post-traumatic headache. J Neurosurg 1944, 1:379–391.CrossRefGoogle Scholar
  3. 3.
    Raskin NH: Post-traumatic headache: the postconcussion syndrome. In Headache, edn 2. Philadelphia: Churchill Livingstone; 1988:269–281.Google Scholar
  4. 4.
    Speed WG: Psychiatric aspects of post-traumatic headaches. In Psychiatric Aspects of Headache. Edited by Adler SM, Adler CS, Packard RC: Baltimore: Williams & Wilkins; 1987:201–206.Google Scholar
  5. 5.
    Branca B, Lake AE, Saper JR: Significant MMPI-2 scale elevations: chronic post-traumatic headache versus chronic daily headache patients. Headache 1992, 32:260.Google Scholar
  6. 6.
    Medina JL: Efficacy of an individualized outpatient program in the treatment of chronic post-traumatic headache. Headache 1992, 32:180–183.PubMedCrossRefGoogle Scholar
  7. 7.
    Rothbart PJ: The role of occipital blockade in refractory posttraumatic and nonpost-traumatic headaches. Headache 1992, 32:268.Google Scholar
  8. 8.
    Headache Classification Committee of the International Headache Society: Classification and diagnostic criteria for headache disorders, cranial neuralgias, and facial pain. Cephalalgia 1988, 8:1–96. It is worth reviewing these earlier definitions and criteria and comparing them with the 2003 criteria to see how thinking has evolved regarding headache throughout the past 15 years.CrossRefGoogle Scholar
  9. 9.
    Packard RC, Ham LP: Post-traumatic headache: determining chronicity. Headache 1993, 33:133–134.PubMedCrossRefGoogle Scholar
  10. 10.
    Aronoff G: Evaluation and Treatment of Chronic Pain, edn 2. Baltimore: Williams & Wilkins; 1993.Google Scholar
  11. 11.
    Packard RC, Ham LP: Incidence of cluster-like post-traumatic headache: an inconsistency. Headache 1996, 7:139–141.Google Scholar
  12. 12.
    Sturzenegger M, DiStefano G: Presenting symptoms and signs after whiplash injury: the influence of accident mechanisms. Neurology 1994, 44:688–693. A very important paper documenting risk factors and accident mechanisms in the production of headache and other symptoms following whiplash.PubMedGoogle Scholar
  13. 13.
    Packard RC: The relationship of neck injury and posttraumatic headache. Curr Pain Headache Rep 2002, 6:301–307.PubMedCrossRefGoogle Scholar
  14. 14.
    Packard RC: Post-traumatic headache: permanency and relationship to legal settlement. Headache 1992, 32:496–500. This study provides evidence to support the concept that permanent PTH does not resolve after resolution of a claim or settlement for most patients.PubMedCrossRefGoogle Scholar
  15. 15.
    Elson LM: The jolt syndrome: muscle dysfunction following low-velocity impact. Pain Manage 1990, 3:317–326.Google Scholar
  16. 16.
    Mersky H, Woodforde JM: Psychiatric sequelae after minor head injury. Brain 1972, 95:521–528.CrossRefGoogle Scholar
  17. 17.
    Cook JB: The effects of minor head injuries sustained in sport and the postconcussional syndrome. In Late Effects of Head Injury. Edited by Walker AE, Caveness WF, Critchley M. Springfield: Charles C. Thomas; 1969:408–413.Google Scholar
  18. 18.
    Trimble MR: Post-traumatic Neurosis: from Railway Spine to the Whiplash. New York: John Wiley & Sons; 1981. A classic that provides a wonderful history of the early head and neck injuries. Litigation has not changed much in the past 100 years.Google Scholar
  19. 19.
    Kelly R, Smith BN: Post-traumatic syndrome: another myth discredited. J R Soc Med 1981, 74:275–277.PubMedGoogle Scholar
  20. 20.
    Packard RC: Treatment of chronic daily post-traumatic headache with divalproex sodium. Headache 2000, 40:736–739.PubMedCrossRefGoogle Scholar
  21. 21.
    Warner JS, Fenichel GM: Chronic post-traumatic headache: Often a myth? Neurology 1996, 46:915–916.PubMedGoogle Scholar
  22. 22.
    Saper JR, Lake AE, Hannel RL, et al.: Daily scheduled opioids for intractable head pain. Neurology 2004, 62:1687–1694. Although not specifically related to chronic PTH, this article gives a realistic overview of the benefits and pitfalls in treating headache patients with daily scheduled opioids.PubMedGoogle Scholar
  23. 23.
    Tatrow K, Blanchard EB, Hickling EJ, et al.: Post-traumatic headache: biopsychosocial comparisons with multiple control groups. Headache 2003, 43:755–766.PubMedCrossRefGoogle Scholar
  24. 24.
    Evans RW, Evans RI, Sharp MJ: The physician’s survey on the post-concussion and whiplash syndromes. Headache 1994, 34:268–274. It often is useful for physicians to look at themselves and their attitudes with regard to working with patients with chronic PTH.PubMedCrossRefGoogle Scholar
  25. 25.
    Packard RC: Epidemiology and pathogenesis of posttraumatic headache. J Head Trauma Rehab 1999, 14:9–21.Google Scholar
  26. 26.
    Ham LP, Andrasik F, Packard RC: Psychopathology in individuals with post-traumatic headache and other pain types. Cephalalgia 1994, 14:118–126.PubMedCrossRefGoogle Scholar
  27. 27.
    Adler CS, Adler SM: Psychotherapy and the headache patient. In Psychiatric Aspects of Headache. Edited by Adler CS, Adler SM, Packard RC. Baltimore: Williams & Wilkins; 1987:313–340.Google Scholar
  28. 28.
    Couch JR, Bearss C: Chronic daily headache in the posttrauma syndrome: relations to extent of head injury. Headache 2001, 41:559–564.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2005

Authors and Affiliations

  • Russell C. Packard
    • 1
  1. 1.Headache and Head Injury ClinicsTexas Tech University School of Medicine, Health Sciences CenterLubbockUSA

Personalised recommendations