Post‐Traumatic Headache: Is It for Real? Crossfire Debates on Headache: Pro

Abstract

Mild traumatic brain injury is very common in Western societies, affecting approximately 1.8 million individuals in the USA. Even though between 30% and 90% of patients develop post-traumatic headache, post-traumatic headache remains a very controversial disorder. Particularly when it comes to chronic post-traumatic headache following mild closed head injury and headache attributed to whiplash injury. Some experts are disputing its existence as a genuine disorder. Indistinct disease classification, unresolved pathophysiological mechanism, and the role of accident-related legal issues further fuel this controversy. The complex combination of pain and neuropsychological symptoms needs further research in understanding the underlying pathophysiological mechanisms associated with the acute headache following trauma but more so the mechanisms associated with the development of chronic pain in some patients. Investigators should refrain from oversimplifying these complex mechanisms as hysteric exaggeration of everyday complains and from implying greed as motivation for this potentially very disabling disease.

Clinical Comparison of 99mTc Exametazime and 123I Ioflupane SPECT in Patients with Chronic Mild Traumatic Brain Injury

“…If a physiological basis for such symptoms can be established, patients can better understand the nature of their symptoms and hopefully be more compliant with treatment, whether it is medical, occupational, physical, or psychological. For example, post traumatic headache, which occurs in up to 70% of patients in the first year and 25% after the first year [11], is frequently debated as an entity due to a variety of factors including medicolegal influences and a pathophysiology that is not completely understood [12]. The possible pathophysiological mechanism may be related to neurogenic inflammation characterized by locally increased blood flow, plasma protein leakage from blood vessels, mast cell degranulation, and platelet aggregation [13].…”

Postconcussion Syndrome: A Physiatrist's Approach

“…Headaches, which are the most frequently reported symptom after concussion, are present in more than 85% of persons who have had a concussion [34]. The International Classification of Headache Disorders, 2nd edition [8] classifies post‐traumatic headaches (PTH) as a secondary headache, distinguished as acute (lasting no more than 3 months) or chronic (persisting longer than 3 months), although the 3‐month distinction was set rather arbitrarily and without a biological basis [35]. Although no defining characteristics are identified, PTH often meets diagnostic criteria for the primary headache subtypes of tension‐type headaches and, less frequently, migraine without aura [36].…”

“…Depending on the nature of the traumatic event, patients may report characteristics of more than one subtype of headache, as described by Lew et al [37], who wrote that the headache may occur “simultaneously or alternatively with various degrees of severity.” Headaches can be due to medication overuse, emotional distress, myofascial pain, occipital neuralgia, referred cervical pain, and vascular etiologies related to the injury itself. Patients with pre‐existing primary headaches may have an exacerbation after trauma, and it has been suggested that the trauma can “bring out” primary headaches in patients with a strong family history of primary headache [35,38]. Medication overuse has been noted to occur in up to 45% of patients with chronic PTH and should be appropriately considered [36].…”

A double-blind, placebo-controlled intervention trial of 3 and 10 mg sublingual melatonin for post-concussion syndrome in youths (PLAYGAME): study protocol for a randomized controlled trial

“…Post-traumatic headaches (PTH) are thought to be particularly resistant to treatment [55,122,123]. Few studies have specifically analyzed how patients respond to treatment [124,125], and none of these were in children.…”