Cerebral Blood Flow in Chronic Posttraumatic Headache

Gilkey, Stephanie J.; Ramadan, Nabih M.; Aurora, Taruna; Welch, K. M. A.

doi:10.1046/j.1526-4610.1997.3709583.x

Cited by 52 publications

(42 citation statements)

References 15 publications

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“…Tentou-se estabelecer uma base orgânica para a sintomatologia decorrente do pós-trauma, incluindo a cefaleia. Há estudos de imagem descrevendo lesões parenquimatosas, diminuição de fluxo sanguíneo cerebral após trauma, com zonas focais de perfusão diminuída e também alterações metabólicas 8,9 . Dor neuropática está tipicamente associada à lesões nervosas consequentes ao trauma, inflamação, isquemia ou outros mecanismos.…”

Section: Discussionunclassified

Cefaleia pós-traumática crônica: relato de caso

Ferreira¹,

Speciali²

2011

Rev. dor

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Section: Discussionunclassified

Cefaleia pós-traumática crônica: relato de caso

Ferreira¹,

Speciali²

2011

Rev. dor

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“…17 Single-photon emission computed tomography (SPECT) has shown decreased cerebral blood flow and abnormally asymmetrical regional blood flow. 18 Brain auditory evoked responses revealed alteration and prolonged latency of some components. 19 PET showed a decrease in the metabolic rate of glucose, and other studies revealed release of inhibitory neurotransmitters and excitatory amino acids.…”

Section: Clinical Featuresmentioning

confidence: 98%

Chronic Post-traumatic Headache—Understanding the Complexities and Treatment Options

Solomon¹

2010

US Neurology

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The complexities of chronic post-traumatic headache (CPTH) date back to its initial recognition. By the mid-1800s the persistence of headache after head injury was acknowledged as a manifestation of brain injury or 'molecular derangement.' However, with the advent of financial compensation for these injuries, the psychologic aspects were thought to be predominant, hence such terms as 'compensation neurosis.' The latter concept persisted into the early decades of the 20th century with more sophisticated terms as 'somatization' and 'conversion disorder'.However, by the late 1800s 'post-concussion syndrome' was considered to be a legitimate ailment comprising the triad of headache, dizziness, and alcohol intolerance. In recent decades, post-traumatic headache has been recognized as having an organic or pathophysiologic basis as well as associated psychologic factors. Terminology and CriteriaThe term CPTH implies an underlying cerebral trauma that is part of the post-concussion syndrome. The International Classification of Headache Disorders, 2nd edition (IHCD) divides criteria for CPTH into pain attributed to moderate or severe head injury and pain attributed to mild head injury.1 The term 'concussion' in Table 1 is not defined, but would include symptoms such as dazed, confused, memory impairment, and dizziness, in addition to headache or brief loss of consciousness, or both. However, mild head injury without concussion or any other of the IHCD criteria can trigger headache. Examples are migraine with aura evoked by heading a ball during soccer or hemiplegic migraine provoked by trivial head trauma. In addition head trauma need not be direct, such as during blast or whiplash injuries. Trauma may be psychologic, as in chronic post-traumatic stress disorder (PTSD). The time limits indicated in the IHCD criteria have been disputed. Many agree that CPTH may develop more than seven days after trauma, but there is evidence that headache beginning more than three months after concussion is a primary headache (migraine or tension-type) rather than due to brain trauma. 2Until there are biologic markers for the condition, seven days is a logical limit. Similarly, the classification of 'chronic' if the headache lasts for more than three months has been disputed as being too short. Criteria of other illnesses define chronic as having a duration of more than six months. The numbers in the classification criteria are arbitrary but necessary operational criteria for research purposes. EpidemiologyThe prevalence of CPTH is uncertain because 80-90% of head injuries are mild and unreported. Studies of prevalence in people who had reported to an emergency department or doctor's office found CPTH prevalence to range from 15 to 42%. 3,4 Women are somewhat more prone to develop CPTH than men. KeywordsPost-concussion syndrome, diffusion tensor imaging, tension-type headache, post-traumatic stress disorder, behavioral medicine Disclosure: The author has no conflicts of interest to declare.

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“…Previous research suggests underlying pathophysiological similarities of migraines and PTH [6][7][8]. The cortical spreading depression associated with migraine is commonly recognized as the electrophysiological substrate of this primary headache disorder [9].…”

Section: Pathophysiologymentioning

confidence: 99%

“…Intracellular sodium, calcium, and chloride in addition to extracellular potassium are all elevated in neurons after head trauma and during migraine exacerbations. Furthermore, both migraine and mTBI result in an excess release of opioids and excitatory amino acids, such as beta-endorphins and glutamate, respectively [6,11].…”

Section: Pathophysiologymentioning

confidence: 99%

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Post-Traumatic Headache Therapy in the Athlete

Seifert

2016

Curr Pain Headache Rep

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Post-traumatic headache can occur after any traumatic brain injury, regardless of severity. Headache is consistently the most common symptom following concussion and occurs in over 90% of athletes with sports-related concussion. Despite this prevalence, the complaint of headache after a possible concussive injury is often dismissed. Even when sports-related concussion is accurately diagnosed, many athletes fall victim to mismanagement of this associated symptom by clinicians who are not well-versed in headache treatment. Furthermore, benign headaches may also occur incidentally in the context of head trauma. This complex, and often non-specific, nature of headaches provides a significant challenge in return to play decision-making. Post-traumatic headaches are generally categorized according to primary headache disorders in an attempt to guide treatment; however, there is minimal medical literature on headache management in the concussed athlete. There is clearly a continued need for prospective studies of existing treatments and new approaches.

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Cerebral Blood Flow in Chronic Posttraumatic Headache

Abstract: Patients with PTH have reduced regional cerebral blood flow, and regional and hemispheric asymmetries. These cerebral hemodynamic alterations support an organic basis to chronic posttraumatic headache.

Cited by 52 publications

References 15 publications

Cefaleia pós-traumática crônica: relato de caso

Cefaleia pós-traumática crônica: relato de caso

Chronic Post-traumatic Headache—Understanding the Complexities and Treatment Options

Post-Traumatic Headache Therapy in the Athlete

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