Post-Traumatic Headache Therapy in the Athlete

Abstract

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.

Short and Long Term Behavioral and Pathological Changes in a Novel Rodent Model of Repetitive Mild Traumatic Brain Injury

“…The most common symptoms observed clinically following a single mTBI include cognitive deficits in the acute stage, typically resolving within months of the initial injury [ 65 ]. Given the prevalence of post-concussive symptoms such as headache persisting for weeks to months following a single injury, the data presented within this study and others suggest that a single mTBI is enough to cause long term pathological changes within the brain [ 66 ]. Animal models have demonstrated that a single mTBI can acutely induce neurodegenerative and neuroinflammatory changes that increase with injury severity, and that this is intensified with repeated trauma [ 67 – 69 ].…”

COACH CV: The Seven Clinical Phenotypes of Concussion

“…Headache is the most common symptom in concussed patients [ 1 ]. Migraine headache, tension headache, cervico-genic headache and post-traumatic headache are all observed in the concussed-patient population [ 31 , 32 , 33 ]. Red flags for the patient with post traumatic headache include a deteriorating level of consciousness, progressive worsening, vomiting, early morning headache and headache worsening in the supine position.…”

“…In a recent case-control observational study, Eckner showed an association between migraine headaches and concussion, concluding that pre-existing migraine headaches are a risk factor for chronic headache reporting after concussion [ 31 ]. Seifert cautioned that headaches could represent an exacerbation of pre-concussion headaches, rather than a new brain injury [ 32 ]. The treatment of post-traumatic migraine or post-traumatic tension headaches was considered important.…”

Concussion Office Based Rehabilitation Assessment: A Novel Clinical Tool for Concussion Assessment and Management

“…Clinical manifestations in the domains of the oculomotor system, affective disturbances, vestibular signs, cardiovascular anomalies, subtypes of headache and somatization are not prompted by the SCAT-5. All these difficulties have been documented in concussed patients, can affect prognosis, and be meritorious of treatment [ 6 , 9 , 10 , 11 , 21 , 23 , 24 , 25 , 26 , 29 ].…”

“…Red flags must always be reviewed with concussion for significant intra-cranial pathology, however, once this has been ruled out, treatment of headache can be based on the specific type of headache documented. The most common headaches associated with concussion have been migraine, tension, post-traumatic and cervicogenic [ 20 , 21 ]. Pre-existing migraines have been associated with poorer outcomes post-concussion.…”