Models for Treating Post-traumatic Headache

Abstract

Purpose of Review To discuss the treatment of post-traumatic headache (PTH) and how to choose pharmacotherapy based upon known pathophysiology. Recent Findings Preclinical models of traumatic brain injury are finally revealing some of the mechanisms of PTH, including the significant role that inflammatory neuropeptides like calcitonin gene-related peptide (CGRP) play in the initiation and persistence of symptoms. Summary To effectively treat post-traumatic headache (PTH), one needs to understand the pathophysiology behind the initiation and persistence of symptoms. Recent animal models are starting to elucidate these mechanisms, but effective treatment will also likely rely on the identification of patients who are most at risk for persistent PTH. Trials of early, targeted therapy for at-risk patients will be needed to validate these hypotheses. Additionally, high powered clinical trials are lacking in the field of persistent PTH for medications that are known to be effective in primary headache disorders. Effective treatment for persistent PTH also requires understanding how headache interacts with the complex nature of persistent post-concussion symptoms, as this disease often necessitates a multi-disciplinary approach. Regardless, with the knowledge gained by new PTH models cited in this paper, and an increasing availability of novel headache medications, more effective treatment models are on the horizon.

Posttraumatic Headache

“…Studies should also include other potential treatments already available and used for other headache types. 114 Additionally, evaluation of when treatments are most effective and the optimum time for starting treatment is also needed. It is possible that early, aggressive treatment of those most at risk of prolonged headaches following an injury may lead to better outcomes.…”

“…It is possible that early, aggressive treatment of those most at risk of prolonged headaches following an injury may lead to better outcomes. 114…”

“…113 As PTH becomes a more chronic problem, understanding how other persistent symptoms from the injury relate to PTH becomes important, as this may help refine treatments and guide decisions with regard to return to play and activities. 114 To better understand PTH, we need to ensure that an appropriate definition is consistently applied. Current ICHD-3 criteria indicate that the headache starts within 7 days of the injury, regaining consciousness, or being off medication.…”

“…113 As PTH becomes a more chronic problem, understanding how other persistent symptoms from the injury relate to PTH becomes important, as this may help refine treatments and guide decisions with regard to return to play and activities. 114…”

Revisiting the ICHD-3 criteria for headache attributed to mild traumatic injury to the head: Insights from the Toronto Concussion Study Analysis of Acute Headaches Following Concussion

“…Unfortunately, there is an extremely limited number of relevant clinical trials upon which to make therapeutic decisions for PTH management. The hope is that with greater clarity in PTH diagnostic criteria, with renewed interest in PTH ( 9 , 10 ) and with promising new emerging therapies, appropriate patients can be enrolled in clinical trials and novel therapeutic agents and treatment strategies can be appropriately evaluated.…”