Posttraumatic Headache: Clinical Characterization and Management
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Headache is the most common symptom after traumatic brain injury (TBI). TBI has become a global health concern with an estimated 2.5 million reported TBIs per year in the USA alone. Recent longitudinal studies of posttraumatic headache (PTH) show a high cumulative incidence of 71 % after moderate or severe TBI and an even higher cumulative incidence of 91 % after mild TBI (mTBI) at 1 year after injury. Prevalence remains high at over 44 % throughout the year after moderate or severe TBI and over 54 % after mTBI. A prior history of headache is associated with a higher risk for PTH, whereas older age appears to be protective. Gender does not appear to be a risk factor for PTH. Most PTH has clinical diagnostic criteria meeting that of migraine or probable migraine when primary headache disorder classification criteria are used, followed by tension-type headache. There are no evidence-based treatment guidelines for PTH management; however, expert opinion has suggested treating the PTH using primary headache disorder treatment recommendations according to its type.
KeywordsPosttraumatic headache Concussion Postconcussion syndrome Tension-type headache Sports concussion Traumatic brain injury
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Conflict of Interest
Sylvia Lucas is a section editor for Current Pain and Headache Reports.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 4.••Centers for Disease Control and Prevention (CDC). Traumatic brain injury statistics 2012. www.cdc.gov/traumaticbraininjury/statistics. This is an excellent website for up-to-date information on concussion, but also for physician and patient access to relevant literature on statistics of occurrence, symptoms, diagnosis and what to expect.
- 5.Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths 2002–2006. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.Google Scholar
- 8.Congressional Research Service communication with Dr. Michael Carino, Army Office of the Surgeon General, September 11th, 2014. Defense Medical Surveillance System (DMSS), Defense and Veterans Brain Injury Center, http://www.dvbic.org/dod-worldwide-numbers-tbi.
- 9.The International Classification of Headache Disorders: Third Edition-beta. 2013. Cephalalgia. 33:629–808.Google Scholar
- 15.••Lucas S, Hoffman JM, Bell KR, Dikmen S. A prospective study of prevalence and characterization of headache following mild traumatic brain injury. Cephalalgia. 2014;34(2):93–102. The importance of this large prospective study was to show that prevalence is higher for PTH after mTBI than after moderate to severe TBI, and also to characterize the PTH with ICHD criteria supporting migraine/probable migraine as the most common PTH type.CrossRefPubMedGoogle Scholar
- 32.•Erickson JC. Treatment outcomes of chronic post-traumatic headaches after mild head trauma in US soldiers: an observational study. Headache. 2011;51(6):932–44. This is an, open label retrospective study in a military population showcasing the difficulty of finding effective treatment for PTH and a high non-responder rate to preventive medication.CrossRefPubMedGoogle Scholar
- 38.••Theeler B, Lucas S, Riechers RG, Ruff RL. Post-traumatic headaches in civilians and military personnel: a comparative, clinical review. Headache. 2013;53(6):881–900. Good comparison of prevalence and characteristics of PTH in the civilian and military populations with remarkable similarity of findings despite etiology of the injury.CrossRefPubMedGoogle Scholar
- 39.Lucas S, Devine J, Bell K, Hoffman J, Dickmen S. Acute neuroimaging abnormalities associated with post-traumatic headache following traumatic brain injury (P04.020). Neurology. 2013;80(American Academy of Neurology meeting abstracts).Google Scholar
- 44.Trivedi N. International School; Youth sports concussion. Presentation to TBI Model Systems group at University of Washington from original research. 2015; personal communication.Google Scholar
- 45.Torres DM, Galetta KM, Phillips HW, et al. Sports-related concussion: anonymous survey of a collegiate cohort. Neurol Clin Pract 2013;3:279–87.Google Scholar
- 53.Defense and Veterans Brain Injury Study Group. Clinical guidance for evaluation and management of concussion/ mTBI-acute/subacute. Deployed and CONUS Setting Versons. 2012. www.dvbic.org/. Accessed 06.21.15.
- 54.Schultz BA, Cifu DX, McNamee S, Nichols M, Carne W. Assessment and treatment of common persistent sequelae following blast-induced mild traumatic brain injury. Neuro Rehab. 2011;28(4):309–20.Google Scholar
- 59.Raskin NH. Post-traumatic headache: The postconcussion syndrome. In: Headache. 2nd edition, N. Raskin, ed. Churchill Livingstone, New York, 1988. pp. 269-281.Google Scholar
- 60.•DiTommaso C, Hoffman JM, Lucas S, Dikmen S, Temkin N, Bell KR. Medication usage patterns for headache treatment after mild traumatic brain injury. Headache. 2014;54(3):511–9. This paper reports a lack of effective therapy for PTH and a very high rate of self-treatment with OTC products, reflecting the need for management strategies and more research in the area of treatment.CrossRefPubMedGoogle Scholar