Posttraumatic headache: recent progress

Abstract

Purpose of review Posttraumatic headache (PTH) attributed to mild traumatic brain injury is common and debilitating. In up to one-half of those with acute PTH, the PTH becomes persistent (PTH), enduring for longer than 3 months. The high incidence and persistence of PTH necessitate research into PTH pathophysiology and treatment. In this review, recent developments regarding the diagnostic criteria for PTH, the pathophysiology of PTH, and PTH treatment are discussed. Recent findings International Classification of Headache Disorders 3 diagnostic criteria for PTH attributed to head trauma require that ‘a headache of any type’ starts within 7 days of a head injury. PTH is considered ‘persistent’ when it endures for more than 3 months. Preclinical and human PTH research suggest multiple pathophysiologic mechanisms including genetic influences, neuroinflammation, increased release and inadequate clearance of neuropeptides and neurotransmitters, mast cell degranulation, and brain structural and functional remodeling. Even when it has a phenotype similar to a primary headache, data suggest that PTH is distinct from primary headaches. There is a lack of high-quality evidence for the acute or preventive treatment of PTH. However, results from published studies of conventional headache therapies and newer therapies, such as calcitonin gene-related peptide mAbs and transcranial magnetic stimulation, justify the current and future randomized controlled trials. Summary Evidence points towards a complex pathophysiology for PTH that is at least partially distinct from the primary headaches. Although properly conducted clinical trials of PTH treatment are needed, existing work has provided important data that help to plan these clinical trials. Current and future investigations will help to identify PTH mechanisms, predictors for PTH persistence, therapeutic targets, and evidence-based treatment options.

Repetitive Neuromuscular Magnetic Stimulation for Pediatric Headache Disorders: Muscular Effects and Factors Affecting Level of Response

“…However, these conditions are considerably underdiagnosed [ 5 , 6 , 7 , 8 , 9 ]. Another common entity is post-traumatic headache (PTH) with the heterogeneous character of migraine-like, TTH-like, daily, or continuous headaches [ 10 , 11 , 12 , 13 , 14 ].…”

Associations between Zygoma Fracture and Post-Traumatic Headache: A Study among Taiwanese Population

“…The PTH diagnosis (ICD-9-CM: 339.2) was not established until 2009. Second, the patients may have had early onset of symptoms but delayed admission for treatment [30] (the medical record in this databank came from the admission data), which implies the timing of medical record was different from that of symptoms onset. The timing discrepancy may lead to misinterpretation of the findings, and readers should be alert to this bias.…”

Glymphatic System Dysfunction: A Novel Mediator of Sleep Disorders and Headaches

“…Globally, there are an estimated 69 million patients with TBI each year ( 45 ), whereas the 1-year prevalence for PTH is 21/100,00 ( 46 ). Moreover, PTH accounts for 4% of all headaches and is the second most common sequelae after TBI ( 47 ). The International Classification of Headache Disorders (ICHD) recently revised the diagnostic criteria for PTH in 2018 ( 48 ), although the criteria remain controversial.…”

“…Nevertheless, PTH has attracted increased attention in recent years. The complex pathogenesis of TBI involves neuronal depolarization and the release of excitatory neurotransmitters, such as glutamate and aspartate, resulting in an increase in intracellular calcium, which induces dramatic changes in the metabolic state of the brain ( 47 , 49 ). In addition, the accumulation of metabolic waste caused by abnormal metabolism in the brain is an important cause of PTH ( 50 ).…”