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Post-traumatic Headache: Pharmacologic Management and Targeting CGRP Signaling

  • Neurotrauma (D. Sandsmark, Section Editor)
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Abstract

Purpose of Review

Post-traumatic headache is a common sequela of injury to the head and/or neck. Here, we review the current approach to pharmacologic management of post-traumatic headache and explore the therapeutic promise of targeting calcitonin gene–related peptide signaling to address unmet treatment needs.

Recent Findings

The scarcity of data from controlled trials has left clinicians to rely on mainly expert opinion for the pharmacologic management of post-traumatic headache. The current view is that a phenotype-guided approach should be used, in which patients are treated according to the primary headache phenotype that their clinical features resemble the most (e.g. migraine, tension-type headache). Moreover, incremental advances are being made in the field that aim to identify possible cellular and molecular drivers of headache persistence. Calcitonin gene–related peptide has emerged as a key drug target which, in turn, has prompted novel insights on the potential importance of early initiation of pharmacologic treatment following the onset of post-traumatic headache. This, in turn, might prevent subsequent persistence and chronification of headache.

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Fig. 1

Modified from Ashina et al., 2021, Lancet Neurol [1]. Recommended doses have been published elsewhere [1]

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Authors and Affiliations

  1. Danish Headache Center, Department of Neurology, Faculty of Health and Medical Sciences, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark

    Håkan Ashina

  2. Department of Neurorehabilitation/Traumatic Brain Injury, Rigshospitalet, Copenhagen, Denmark

    Håkan Ashina

  3. Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA

    David W. Dodick

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Correspondence to David W. Dodick.

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Conflict of Interest

David W. Dodick reports the following conflicts within the past 12 months: consulting: Amgen, Atria, Cerecin, Cooltech, Ctrl M, Allergan, Biohaven, GSK, Lundbeck, Eli Lilly, Novartis, Impel, Satsuma, Theranica, WL Gore, Nocira, Perfood, Praxis, AYYA Biosciences, Revance. Honoraria: Vector psychometric Group, Clinical Care Solutions, CME Outfitters, Curry Rockefeller Group, DeepBench, Global Access Meetings, KLJ Associates, Academy for Continued Healthcare Learning, Majallin LLC, Medlogix Communications, MJH Lifesciences, Miller Medical Communications, WebMD Health/Medscape, Wolters Kluwer, Oxford University Press, Cambridge University Press. Research Support: Department of Defense, National Institutes of Health, Henry Jackson Foundation, Sperling Foundation, American Migraine Foundation, Patient Centered Outcomes Research Institute (PCORI). Stock Options/Shareholder/Patents/Board of Directors: Ctrl M (options), Aural analytics (options), ExSano (options), Palion (options), Healint (Options), Theranica (Options), Second Opinion/Mobile Health (Options), Epien (Options/Board), Nocira (options), Matterhorn (Shares/Board), Ontologics (Shares/Board), King-Devick Technologies (Options/Board), Precon Health (Options/Board), AYYA Biosciences (Options). Patent 17189376.1–1466:vTitle: Botulinum Toxin Dosage Regimen for Chronic Migraine Prophylaxis. Håkan Ashina reports no potential conflicts of interest.

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Ashina, H., Dodick, D.W. Post-traumatic Headache: Pharmacologic Management and Targeting CGRP Signaling. Curr Neurol Neurosci Rep 22, 105–111 (2022). https://doi.org/10.1007/s11910-022-01175-w

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