Abstract
Purpose
The purpose of this paper is to review and outline the similarities and differences in the treatment of athletes compared with that of other populations with a persistent post-traumatic headache after a concussion.
Recent Findings
After an extensive review of the literature and despite well over 2 million Americans experiencing post-traumatic headache (PTH) each year, a number of which will continue to experience persistent post-traumatic headache (PPTH). There is little evidence on the management of the disorder and essentially no evidence-based research when it comes to the management of athletes.
Summary
With little evidence available for the treatment of individuals with PPTH, be it athletes or non-athletes, the clinician will need to rely on their experience and the application of existing treatments for migraine and chronic migraine. Clearly, more research is needed, especially with respect to the management of athletes versus non-athletes.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Cancelliere C, Coronado VG, Taylor CA, Xu L. Epidemiology of isolated versus nonisolated mild traumatic brain injury treated in emergency departments in the United States, 2006–2012: Sociodemographic Characteristics. J Head Trauma Rehabil. 2017;32(4):E37–46. https://doi.org/10.1097/HTR.0000000000000260.
Amoo-Achampong K, Rosas S, Schmoke N, Accilien Y-D, Nwachukwu BU, McCormick F. Trends in sports-related concussion diagnoses in the USA: a population-based analysis using a private-payor database. Phys Sportsmed. 2017;45(3):239–44. https://doi.org/10.1080/00913847.2017.1327304.
Theeler B, Lucas S, Riechers RG II, Ruff RL. Post-traumatic headaches in civilians and military personnel: a comparative, clinical review. Headache. 2013;53:881–900. https://doi.org/10.1111/head.12123.
Larsen EL, Ashina H, Iljazi A, et al. Acute and preventive pharmacological treatment of post-traumatic headache: a systematic review. J Headache Pain. 2019;20(1):98. https://doi.org/10.1186/s10194-019-1051-7.
Bezherano I, Haider MN, Willer BS, Leddy JJ. Practical management: prescribing subsymptom threshold aerobic exercise for sport-related concussion in the outpatient setting. Clin J Sport Med. 2020:13. https://doi.org/10.1097/JSM.0000000000000809.
Elliott MB, Ward SJ, Abood ME, Tuma RF, Jallo JI. Understanding the endocannabinoid system as a modulator of the trigeminal pain response to concussion. Concussion. 2017;2(4):CNC49. https://doi.org/10.2217/cnc-2017-0010.
Ingrasciotta Y, Sultana J, Giorgianni F, et al. Association of individual non-steroidal anti-inflammatory drugs and chronic kidney disease: a population-based case control study. PLoS One. 2015;10(4):e0122899. https://doi.org/10.1371/journal.pone.0122899.
Conidi FX. Sports-related concussion: the role of the headache specialist. Headache. 2012;52:15–21. https://doi.org/10.1111/j.1526-4610.2012.02138.x.
Bogduk N. The clinical anatomy of the cervical dorsal rami. Spine. 1982;7:319.
Hecht J. Occipital nerve blocks in postconcussive headaches: a retrospective review and report of ten patients. J Head Trauma Rehabil. 2004;19:58–71.
Seeger TA, Orr S, Bodell L, Lockyer L, Rajapakse T, Barlow KM. Occipital nerve blocks for pediatric posttraumatic headache: a case series. J Child Neurol. 2015;30(9):1142–6. https://doi.org/10.1177/0883073814553973.
Dubrovsky AS, Friedman D, Kocilowicz H. Pediatric post-traumatic headaches and peripheral nerve blocks of the scalp: a case series and patient satisfaction survey. Headache. 2014;54(5):878–87.
Cady R, Saper J, Dexter K, Manley HR. A double-blind, placebo-controlled study of repetitive transnasal sphenopalatine ganglion blockade with Tx360® as acute treatment for chronic migraine. Headache. 2015;55(1):101–16.
Tepper SJ. Nutraceutical and other modalities for the treatment of headache. Continuum. (Minneap Minn). Headache. 2015;21(4):1018–31. https://doi.org/10.1212/CON.0000000000000211.
Charles A, Flippen C, Romero Reyes M, Brennan KC. Memantine for prevention of migraine: a retrospective study of 60 cases. J Headache Pain. 2007;8(4):248–50. https://doi.org/10.1007/s10194-007-0406-7.
• Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1): 1–211. https://doi.org/10.1177/0333102417738202. This article gives us a template to define the various phenotypes of headache seen in concussion, mTBI, and TBI. It also needs to be updated with respect to its definitions of PTH, which are outdated and do not reflect real-world clinical experience.
•• Navratilova E, Rau J, Oyarzo J, Tien J, Mackenzie K, Stratton J, et al. CGRP-dependent and independent mechanisms of acute and persistent post-traumatic headache following mild traumatic brain injury in mice. Cephalalgia. 2019;39(14):1762–75. https://doi.org/10.1177/0333102419877662This study is one of the first implicating CGRP as a player in PPTH. It will help pave the way for human studies and lends support for the use of GCRP monoclonal antibodies in the treatment of this type of headache.
• Yerry, J.A., Kuehn, D. and Finkel, A.G. (2015), Onabotulinum toxin a for the treatment of headache in service members with a history of mild traumatic brain injury: a cohort Study. Headache 55: 395–406. doi:https://doi.org/10.1111/head.12495. One of the few studies that look at the treatment of Chronic PTH.
Conidi FX. Interventional treatment for post-traumatic headache. Curr Pain Headache Rep. 2016;20:40. https://doi.org/10.1007/s11916-016-0570-z.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Francis X Conidi has received honoraria from Medlink and has served on the speaker and advisory boards of Allergan, Teva, and Amgen. He has served as a consultant for the National Football League, National Hockey League, Major League Baseball, Your Call Football League, and NCAA.
Human and Animal Rights Informed Consent
This article does not contain any studies with animal subjects performed by the author.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Concussion and Head Injury
Rights and permissions
About this article
Cite this article
Conidi, F.X. Post Traumatic Headache: Clinical care of athletes vs non athletes with Persistent Post Traumatic Headache after Concussion: Sports Neurologist and Headache Specialist Perspective. Curr Pain Headache Rep 24, 65 (2020). https://doi.org/10.1007/s11916-020-00889-1
Published:
DOI: https://doi.org/10.1007/s11916-020-00889-1