Current Pain and Headache Reports

, Volume 14, Issue 4, pp 292–298 | Cite as

Posttraumatic Headache: A Review

  • Tad D. SeifertEmail author
  • Randolph W. Evans


There has been intense controversy about postconcussion syndrome (PCS) since Erichsen’s publication in 1866 on railway brain and spine. Headache as a result of trauma is one of the most common secondary headache types. Posttraumatic headache (PTH) remains a very controversial disorder, particularly with relation to chronic PTH following mild closed-head injury. PTH is one of several symptoms of PCS, and therefore may be accompanied by additional cognitive, behavioral, and somatic problems. PTH also is an important public health issue due to its associated disability and often refractory clinical course. While current awareness of PTH has become more prominent due to increased scrutiny given to both combat-related and sports-related head injuries, directed treatment remains a difficult challenge for physicians. Because of the frequently associated medicolegal aspects, PTH is one of physicians’ least favorite types to treat. The article reviews both PCS and PTH.


Posttraumatic headache Traumatic brain injury (TBI) Postconcussion syndrome Combat-related headache Sports-related headache 



No potential conflicts of interest relevant to this article were reported.


Papers of particular interest, published recently, have been highlighted as: •Of importance •• Of outstanding importance

  1. 1.
    •• Solomon S: Post-traumatic headache: commentary: an overview. Headache 2009, 49:1112–1115. This thorough yet concise overview of PTH discusses history, clinical features, etiology, and treatment. CrossRefPubMedGoogle Scholar
  2. 2.
    Faux S, Sheedy J: A prospective controlled study in the prevalence of posttraumatic headache following mild traumatic brain injury. Pain Med 2008, 9:1001–1011.CrossRefPubMedGoogle Scholar
  3. 3.
    Evans R: Expert opinion: posttraumatic headaches among United States soldiers injured in Afghanistan and Iraq. Headache 2008, 48:1216–1225.CrossRefPubMedGoogle Scholar
  4. 4.
    Miller H: Accident neurosis. Br Med J 1961, 1:919–925.CrossRefPubMedGoogle Scholar
  5. 5.
    Centers for Disease Control and Prevention: Get the Stats on Traumatic Brain Injury in the United States: 2002–2006. Available at Accessed January 2010.
  6. 6.
    Cassidy JD, Carroll LJ, Peloso PM, et al.: Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med 2004, 36(Suppl 43):28–60.CrossRefGoogle Scholar
  7. 7.
    Evans RW: The postconcussion syndrome and the sequelae of mild head injury. In Neurology and Trauma, edn. 2. Edited by Evans RW. New York: Oxford University Press; 2006:95–128.Google Scholar
  8. 8.
    • Evans RW: Postconcussion syndrome. Available at Accessed January 2010. This extremely thorough review discusses past and recent controversies, clinical characteristics, and the prognosis of PCS.
  9. 9.
    Jennett B, Frankowski RF: The epidemiology of head injury. In Handbook of Clinical Neurology, vol. 13. Edited by Braakman R. New York: Elsevier, 1990:1–16.Google Scholar
  10. 10.
    Headache Classification Subcommittee of the International Headache Society: The International Classification of Headache Disorders: 2nd edition). Cephalalgia 2004, 24(Suppl 1):9–160Google Scholar
  11. 11.
    Lord SM, Barnsley L, Wallis BJ, Bogduk N: Third occipital headache: a prevalence study. J Neurol Neurosurg Psychiatry 1994, 57:1187–1190.CrossRefPubMedGoogle Scholar
  12. 12.
    Weinstock A, Rothner AD: Trauma-triggered migraine: a cause of transient neurologic deficit following minor head injury in children. Neurology 1995, 45(Suppl 4):A347–A348.Google Scholar
  13. 13.
    Goadsby PJ: Pathophysiology of cluster headache: a trigeminal autonomic cephalgia. Lancet Neurol 2002, 1:251–257.CrossRefPubMedGoogle Scholar
  14. 14.
    Bahra A, May A, Goadsby PJ: Cluster headache: a prospective clinical study with diagnostic implications. Neurology 2002, 58:354–361.PubMedGoogle Scholar
  15. 15.
    Ekbom K: Lifestyle factors in males with cluster headache. Cephalalgia 1999, 19:73–74.CrossRefPubMedGoogle Scholar
  16. 16.
    Moriyama E, Ogawa T, Nishida A, et al.: Quantitative analysis of radioisotope cisternography in diagnosis of intracranial hypotension. J Neurosurg 2004, 101:421–426.CrossRefPubMedGoogle Scholar
  17. 17.
    Vilming ST, Campbell JK: Low cerebrospinal fluid pressure. In The Headaches, edn. 2. Edited by Olesen J, Tfelt-Hansen P, Welch KM. Philadelphia: Lippincott Williams & Wilkins; 2000:831–839.Google Scholar
  18. 18.
    Bogduk N: The neck and headaches. Neurol Clin 2004, 22:151–171.CrossRefPubMedGoogle Scholar
  19. 19.
    Balla J, Jansek R: Headaches arising from disorders of the cervical spine. In Headache: Problems in Diagnosis and Management. Edited by Hopkins A. Philadelphia: W. B. Saunders; 1998:241–267.Google Scholar
  20. 20.
    Radanov BP, Sturzenegger M, Di Stefano G: Long term outcome after whiplash injury. Medicine (Baltimore) 1995, 74:281–297.CrossRefGoogle Scholar
  21. 21.
    Rozen T: Post-traumatic external nasal pain syndrome (a trigeminal based pain disorder). Headache 2009, 49:1223–1228.CrossRefPubMedGoogle Scholar
  22. 22.
    Putzki N, Nirkko A, Diener HC: Trigeminal autonomic cephalgias: a case of post-traumatic SUNCT syndrome? Cephalalgia 2005, 25:395–397.CrossRefPubMedGoogle Scholar
  23. 23.
    Lewine JD, Davis JT, Sloan JH, et al.: Neuromagnetic assessment of pathophysiologic brain activity induced by minor head trauma. AJNR Am J Neuroradiol 1999, 20:857–866.PubMedGoogle Scholar
  24. 24.
    •• Singh M, Jeong J, Hwang D, et al.: Novel diffusion tensor imaging methodology to detect and quantify injured regions and affected brain pathways in traumatic brain injury. Magn Reson Imaging 2010, 1:22–40. This thought-provoking case-controlled study investigates the application of diffusion tensor imaging in the detection and quantification of sites of TBI. CrossRefGoogle Scholar
  25. 25.
    • Kraus MF, Susmaras T, Caughlin BP, et al.: White matter integrity and cognition in chronic traumatic brain injury: a diffusion tensor imaging study. Brain 2007, 130:2508–2519. This case-controlled study investigates white matter integrity post-TBI of all severities via diffusion tensor imaging. CrossRefPubMedGoogle Scholar
  26. 26.
    MacKenzie JD, Siddiqi F, Babb JS, et al.: Brain atrophy in mild or moderate traumatic brain injury: a longitudinal quantitative analysis. AJNR Am J Neuroradiol 2002, 23:1509–1515.PubMedGoogle Scholar
  27. 27.
    Bazarian JJ, Zhong J, Blyth B, et al.: Diffusion tensor imaging detects clinically important axonal damage after mild traumatic brain injury: a pilot study. J Neurotrauma 2007, 24:1447–1459.CrossRefPubMedGoogle Scholar
  28. 28.
    Ruff R: Two decades of advances in understanding of mild traumatic brain injury. J Head Trauma Rehabil 2005, 20:5–18.CrossRefPubMedGoogle Scholar
  29. 29.
    Evans RW: Persistent post-traumatic headache, postconcussion syndrome, and whiplash injuries: the evidence for a non-traumatic basis with a historical review. Headache 2010, 50:716–724.CrossRefPubMedGoogle Scholar
  30. 30.
    Ommaya AK, Ommaya AK, Dannenberg AL, Salazar AM: Causation, incidence and costs of traumatic brain injury in the U.S. Military Medical System. J Trauma 1996, 40:211–217.CrossRefPubMedGoogle Scholar
  31. 31.
    Helseth EK, Erickson JC: The prevalence and impact of Migraines on US Military officer trainees. Headache 2008, 48:883–889.CrossRefPubMedGoogle Scholar
  32. 32.
    Theeler BJ, Mercer R, Erickson JC: Prevalence and impact of migraine among US Army soldiers deployed in support of Operation Iraqi Freedom. Headache 2008, 48:876–882.CrossRefPubMedGoogle Scholar
  33. 33.
    •• Vargas BB: Posttraumatic headache in combat soldiers and civilians: what factors influence the expression of tension-type versus migraine headache? Curr Pain Headache Rep 2009, 13:470–473. This thoughtful article explores the features unique to the combat environment that predispose to the expression of migraine headache post-TBI. CrossRefPubMedGoogle Scholar
  34. 34.
    Hoge CW, McGurk D, Thomas JL, et al.: Mild traumatic brain injury in U.S. soldiers returning from Iraq. N Engl J Med 2008, 358:453–463.CrossRefPubMedGoogle Scholar
  35. 35.
    • Schwab KA, Ivins B, Cramer G, et al.: Screening for traumatic brain injury in troops returning from Deployment in Afghanistan and Iraq: initial investigation of the usefulness of a short screening tool for traumatic brain injury. J Head Trauma Rehabil 2007, 22:377–389. This informative article details a preliminary assessment of a screening instrument aimed to identify individuals having suffered TBI. CrossRefPubMedGoogle Scholar
  36. 36.
    Department of Veterans Affairs Office of Inspector General: Follow-up Healthcare Inspection. VA’s Role in Ensuring Services for Operation Enduring Freedom/Operation Iraqi Freedom Veterans after Traumatic Brain Injury Rehabilitation. Available at Accessed June 2008.
  37. 37.
    Thurman DJ, Branche CM, Sniezek JE: The epidemiology of sports-related traumatic brain injuries in the United States: recent developments. J Head Trauma Rehabil 1998, 13:1–8.PubMedGoogle Scholar
  38. 38.
    McCrea M, Guskiewicz KM, Marshall SW, et al.: Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. JAMA 2003, 290: 2556–2563.CrossRefPubMedGoogle Scholar
  39. 39.
    Collins MW, Lovell MR, Iverson GL, et al.: Examining concussion rates and return to play in high school football players wearing newer helmet technology: a three-year prospective cohort study. Neurosurgery 2006, 58:275–286.CrossRefPubMedGoogle Scholar
  40. 40.
    Schwarz A: N.F.L. Issues New Guidelines on Concussions. Available at Accessed December 2009.
  41. 41.
    Guskiewicz KM, Weaver NL, Padua DA, Garrett WE Jr: Epidemiology of concussion in collegiate and high school football players. Am J Sports Med 2000, 28:643–650.PubMedGoogle Scholar
  42. 42.
    Sallis RE, Jones K: Prevalence of headaches in football players. Med Sci Sports Exerc 2000, 32:1820–1824.CrossRefPubMedGoogle Scholar
  43. 43.
    Ingebrigtsen T, Waterloo K, Marup-Jensen S, et al.: Quantification of post-concussion symptoms 3 months after minor head injury in 100 consecutive patients. J Neurol 1998, 245:609–612.CrossRefPubMedGoogle Scholar
  44. 44.
    Mihalik JP, Stump JE, Collins MW, et al.: Posttraumatic migraine characteristics in athletes following sports-related concussion. J Neurosurg 2005, 102:850–855.CrossRefPubMedGoogle Scholar
  45. 45.
    •• McKee AC, Cantu RC, Nowinski CJ, et al.: Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. J Neuropathol Exp Neurol 2009, 68:709–735. This comprehensive article reviews the history, clinical features, and pathophysiology of CTE. CrossRefPubMedGoogle Scholar
  46. 46.
    Cajigal S: Brain Damage May Have Contributed to Former Wrestler’s Violent Demise. Neurology Today 1997, 7:1, 16.Google Scholar
  47. 47.
    Guskiewicz KM, Marshall SW, Bailes J, et al.: Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery 2005, 57:719–726.CrossRefPubMedGoogle Scholar
  48. 48.
    • Gladstone J: From psychoneurosis to ICHD-2: an overview of the state of the art in post-traumatic headache. Headache 2009, 49:1097–1111. This thorough review highlights the classification, epidemiology, evaluation, and management of PTH. CrossRefPubMedGoogle Scholar
  49. 49.
    Loder E, Biondi D: Use of botulinum toxins for chronic headaches: a focused review. Clin J Pain 2002, 18:169–176.CrossRefGoogle Scholar
  50. 50.
    Evans EW: The Postconcussion Syndrome. In Neurology and General Medicine edn. 4. Edited by Aminoff M. Philadelphia: Elsevier; 2007:593–603.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Norton Neuroscience InstituteLouisvilleUSA
  2. 2.Baylor College of MedicineHoustonUSA

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