Trauma-triggered migraine: an explanation for common neurological attacks after mild head injury

Abstract

This paper reviews the literature on complex temporary disturbances of brain function triggered by mild blows to the head in children, adolescents, and young adults. It consolidates the evidence by which these attacks have been identified as classical or complicated migraines, and provides a historical account of the descriptions and proffered explanations of these attacks. The clinical features and the electroencephalography, angiography, computerized tomography, and cerebrospinal fluid findings of trauma-induced migraine are presented and compared to those of spontaneous migraine. Ideas about the pathogenesis of this condition are related to current thinking on the neurological phenomena of migraine in general.

Delayed, Transient Neurological Deterioration After Mild Head Injury. Case Report.

“…in previously reported cases of JHTS in which the delay between head injury and the onset of the neurological episodes varied from several seconds, minutes, and hours up to 2 days, 7,8,25,27,29) and the episodes lasted from several minutes to several days. Presumably, the majority of the acute type of JHTS, especially those at intervals of several seconds or minutes, involve electrical and/or neuronal reflex phenomena such as cortical spreading depression 25,29) or a trigeminovascular response, because these phenomena appear immediately after the input of stimuli.…”

“…Presumably, the majority of the acute type of JHTS, especially those at intervals of several seconds or minutes, involve electrical and/or neuronal reflex phenomena such as cortical spreading depression 25,29) or a trigeminovascular response, because these phenomena appear immediately after the input of stimuli. 7,27) Our case cannot be classified as the acute type of JHTS.…”

“…6,7,25,29) CT found no pathological abnormalities in nine of 12 cases of JHTS. 27) Exceptional CT findings in one case with diffuse cerebral swelling and in another with hemispheric swelling after mild head injury were considered to reflect vasodilation and not edema.…”

“…10) This finding suggests that hyperemia is involved in mild head injury, although the majority of patients regain normal autoregulation. 7,8,25,27,29) Post-traumatic hyperemia can be divided into malignant and benign types depending on the association with intracranial hypertension. 4,[12][13][14][15]19,23,26,27) Analysis of intracranial pressure and cerebral blood flow in 59 patients with moderate or severe head injuries showed that the median duration of hyperemia associated with intracranial hypertension was longer (median 6 days, range 1-14 days) than that of hyperemia without intracranial hypertension (median 2.5 days, range 0-5 days).…”

“…7,8,25,27,29) Almost all of the symptoms characteristically appear within 48 hours, usually within several hours, after craniofacial injury. 7,8,25,27,29) JHTS has recently been classified into acute and delayed types on the basis of whether symptoms appear before or after 48 hours. 27) However, any difference in the pathophysiologies for these types has not been identified.…”