Post-Traumatic Headache: A Review of Prevalence, Clinical Features, Risk Factors, and Treatment Strategies

Abstract

Post-traumatic headache (PTH) is a common and debilitating consequence of mild traumatic brain injury (mTBI) that can occur over one year after the head impact event. Thus, better understanding of the underlying pathophysiology and risk factors could facilitate early identification and management of PTH. There are several factors that could influence the reporting of PTH prevalence, including the definition of concussion and PTH. The main risk factors for PTHs include a history of migraines or headaches, female gender, younger age, greater severity of the head injury, and co-occurring psychological symptoms, such as anxiety and depression. PTH clinical profiles vary based on onset, duration, and severity: tension-type headache, migraine headaches, cervicogenic headache, occipital neuralgia, and new daily persistent headache. Pharmacological treatments often consist of analgesics and non-steroidal anti-inflammatory drugs, tricyclic antidepressants, or antiepileptic medication. Cognitive behavioral therapy, relaxation techniques, biofeedback, and physical therapy could also be used for PTH treatment. Our work highlighted the need for more rigorous studies to better describe the importance of identifying risk factors and patient-centered treatments and to evaluate the effectiveness of the existing treatment options. Clinicians should consider a multidisciplinary approach to managing PTH, including pharmacotherapy, cognitive behavioral therapy, and lifestyle changes.

Posttraumatic headache is a distinct headache type from migraine

“…Worldwide, an estimated 69 million people suffer from TBI annually, of which around 80% are mTBI [27]. After mTBI, 37–69% of patients report PTH [5–7,8 ▪ ]. Migraine is one of the most common primary headaches with a prevalence of 14.0%, second only to TTH with a prevalence of 26.0% [7].…”

“…These relationships between PTH and migraine have led to questions about whether PTH attributed to mTBI is truly a distinct headache type, as opposed to a TBI worsening preexisting migraine or triggering migraine onset. The following sections provide an overview of the reasons for this debate and the evidence that PTH attributed to mTBI is a distinct headache type, adding several critical aspects to the excellent reviews of PTH in the last few years [8 ▪ ,9,10]…”

Inflammation, brain connectivity, and neuromodulation in post-traumatic headache

“…Pharmacological therapies are used for tension- and migraine-like headaches in PTH patients, including analgesics and non-steroidal anti-inflammatory agents ( Heyer and Idris, 2014 ; Mavroudis et al, 2023 ). Interestingly, although analgesics and non-steroidal anti-inflammatories can be prescribed for the acute phase of PTH, one study showed that acute administration of ibuprofen, acetaminophen, or both did not decrease the incidence of headaches seven days after injury in children and youth (aged 5–18 years) ( Ledoux et al, 2022 ).…”

Subjective and Objective Improvement in a 39-Year-Old Male Suffering From Severe Chronic Pain and Disability Using Chiropractic BioPhysics® Protocols Following Rear-Impact Motor Vehicle Crash With a 10-Month Long-Term Follow-Up

“…At initial rehabilitation, the assessment included history, orthopedic tests, neurological testing, balance assessment, and grip strength, measured along with visual range of motion (ROM) for pain and full-spine upright radiography. The patient reported near-constant head pain measured on the HDI (98/100), indicating severe disability [ 10 ]. Constant NP-causing disability found using the NDI (64/100) indicated severe disability [ 11 ].…”