Opinion statement
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Headache is the most common symptom after closed head injury, persisting for more than 2 months in 60% of patients [1]. Rarely does headache occur in isolation. Cervical pain is a frequent accompaniment. Post-traumatic headache is often one of several symptoms of the postconcussive syndrome, and therefore may be accompanied by additional cognitive, behavioral, and somatic problems.
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Acute post-traumatic headaches may begin at the time of injury and continue for up to 2 months post-injury. Although onset proximate to the time of injury is most common, any new headache type occurring within this period of time is referred to as an acute post-traumatic headache. If such headaches persist beyond the first two months post-injury, they are subsequently referred to as chronic post-traumatic headaches. Over time, post-traumatic headaches may take on a pattern of daily occurrence. If aggressive treatment is initiated early, posttraumatic headache is less likely to become a permanent problem. Once “windup” of post-traumatic headaches occurs, the cycle of ongoing headaches is more difficult to interrupt.
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The mechanism of post-traumatic headache is poorly understood. Trauma-induced headaches are usually heterogeneous in nature, often including both tension-type pain and intermittent migraine-like attacks. Rebound-headaches may develop from overuse of analgesic medications, and the occurrence of such may complicate significantly the diagnosis of post-traumatic headache.
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Adequate treatment typically requires both “peripheral” and “central” measures. Understanding the general principles of treatment, especially appropriate use of preventive and abortive medications, will most usefully guide treatment. There is scant literature with which to direct treatment selection for post-traumatic headache. Consequently, treatments for post-traumatic headache are based on those prescribed for phenomenologically similar but etiologically distinct headache disorders.
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Delayed recovery from post-traumatic headache may be a result of inadequately aggressive or ineffective treatment, overuse of analgesic medications resulting in analgesia rebound phenomena, or comorbid psychiatric disorders (eg, post-traumatic stress disorder, insomnia, substance abuse, depression, or anxiety).
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References and Recommended Reading
Saper J, Silberstein S, Gordon C, Hamel R: Handbook of Headache Management.ed 2, Baltimore: Williams and Wilkins; 2000. This is the most useful reference for physicians in managing headache issues.
Haas D: Chronic post-traumatic headaches classified and compared with natural headaches. Cephalalgia 1996, 16:486–493.
Packard R, Ham L: Pathogenesis of post-traumatic headache and migraine: a common headache pathway? Headache 1997, 37:142–152.
Bogduk N, Jensen R: Anatomy and pathology of tension-type headache. In The Headaches, edn 2. Edited by Olsen J, Tfelt-Hansen P, Welch KMA. Philadelphia: Lippincott Williams and Wilkins; 2000:551–559.
Duke University Center for Clinical Health Policy Research: Drug treatments for the prevention of migraine headache. In Technical Review 2.3. Rockville: Agency for Health Care Policy and Research; 1999:6.
Silberstein S, Goadsby P: Migraine Prevention. Applying Evidence-Based Medicine to Clinical Practice. Philadelphia, PA: Office of Continuing Medical Education, Jefferson Medical College; 2000. This up-to-date review of treatment based on clinical research that also offers tips on setting up a complete headache treatment program.
Rapoport A, Weeks R: Analgesic rebound headache. In Headache: A Clinicians Guide to Diagnosis, Pathophysiology and Treatment Strategies. Edited by Rapoport A, Sheftell F. Los Alamitos, CA: PMA Publishing Corp; 1993:157–165.
Packard RC, Ham LP: Post-traumatic Headache. Semin Headache Manage 1997; 2:1–4. This article includes definitions, epidemiology, mechanism, evaluation, management, prognosis, and review of legal issues.
Packard RC: Post-traumatic headache: permanency and relationship to legal settlement. Headache 1992, 32:496–500.
Packard RC: What does the headache patient want? Headache 1979, 19:370–374.
Tfelt-Hansen P, Welch KMA: Prioritizing prophylactic treatment of migraine. In The Headaches, edn 2. Edited by Olsen J, Tfelt-Hansen P, Welch KMA. Philadelphia: Lippincott Williams and Wilkins; 2000:499–500.
Markley H, Cheronis J, Piepho R: Verapamil and prophylactic therapy of migraine. Neurology 1984, 34:973–976.
Solomon G, Steel J, Spaccavento L: Verapamil prophylaxis of migraine: a double blind, placebocontrolled study. JAMA 1983, 250:2500–2502.
Leandri M, Rigargo S, Schizzi R, Parodi C: Migraine treatment with nicardipine. Cephalalgia 1990, 10:111–116.
Tfelf-Hansen P, Standnes B, Kangasniemi P, et al.: Timolol versus propranolol versus placebo in common migraine prophylaxis: a double-blind multicenter trial. Acta Neurol Scand 1984, 69:1–8.
Borgesen S: Treatment of migraine with propranolol. Postgrad Med J 1976, 52(suppl):163–165.
Weber R, Reinmuth O: The treatment of migraine with propranolol. Neurology 1972, 22:366–369.
Tyler G, McNeely H, Dick M: Treatment of posttraumatic headache with amitriptyline. Headache 1980, 20:213–216.
Label L: Treatment of post-traumatic headache: maprotiline or amitriptyline [poster]? Neurology 1991, 41(suppl):247.
Saran A: Antidepressants not effective in headache associated with minor closed head injury. Int J Psychiatry Med 1988, 18:75–83.
Saper JR, Lake AE, Tepper SJ: Nefazodone for chronic daily headache prophylaxis: an open label study. Headache 2001, 41:465–474.
Adelman L, Adelman J, Von Seggern R, Mannix L: Venlafaxine extended release (XR) for the prophylaxis of migraine and tension-type headache: a retrospective study in a clinical setting. Headache 2000, 40:572–580.
Wroblewski BA, McColgan K, Smith K, et al.: The incidence of seizures during tricyclic antidepressant drug treatment in a brain-injured population. J Clin Psychopharmacol 1990, 10:124–128.
Mathew N: Diagnosis and modern treatment of migraine. Progr Neurology 1999, 1:3–24. A complete update on migraine.
Mathew N, Saper J, Silberstein S, et al.: Migraine prophylaxis with divalproex. Arch Neurol 1995, 52:281–286.
Packard RC: Treatment of chronic daily headache with divalproex sodium. Headache 2000, 40:736–739.
Di Trapini G, Mei D, Marra S, Capuano A: Gabapentin in the prophylaxis of migraine: a double-blind randomized placebo-controlled study. Clinica Therapeutica 2000, 151:145–148.
Wheeler S, Carrazana E: Topirimate-treated cluster headache. Neurology 1999, 53:234–236.
Potter D, Hart D, Calder C, Storey J: A double-blind, randomized, placebo-controlled study of topirimate in the prophylactic treatment of migraine with and without aura. Cephalalgia 2000, 20:305.
Shuaib A: Efficacy of topirimate in prophylaxis of frequent severe migraines or chronic daily headaches: experience with 68 patients over 18 months. Cephalalgia 2000, 20:423.
Lindegaard K, Ovrelid L, Sjaastad O: Naproxen in the prevention of migraine attacks: a double-blind placebo-controlled cross-over study. Headache 1980, 20:96–98.
Solomon S, Newman LC: Chronic daily bilateral headache responsive to indomethacin. Headache 1999, 39:754–757.
Hannerz J: Chronic bilateral headache responding to indomethacin. Headache 2000, 40:840–843.
Antonaci F, Pareja JA, Caminero AB, Sjaastad O: Chronic paroxysmal hemicrania and hemicrania continua. Parenteral indomethacin: the indotest. Headache 1998, 38:122–128.
Sjaastad O, Spierings EL: Hemicrania continua: another headache absolutely responsive to indomethacin. Cephalalgia 1984, 4:65–70.
Geaney DP: Indomethacin-responsive episodic cluster headache. J Neurology Neurosurgery Psychiatry 1983, 46:860–861.
Medina JL: Organic headaches mimicking chronic paroxysmal hemicrania. Headache 1992, 32:73–74.
Saper J, Winner P, Lake A: The safety and efficacy of tizanidine HCl in prophylaxis of chronic daily headaches [poster]. Montreal, Canada: American Headache Society; 2000.
Murros K, Kataja M, Hedman C, et al.: Modified release formulation of tizanadine in chronic tension type headache. Headache 2000, 40:633–637.
Mathew N, Schoenen J: Acute pharmacology of tension type headache. In The Headaches, edn 2. Edited by Olsen J, Tfelt-Hansen P, Welch KMA. Philadelphia: Lippincott Williams and Wilkins; 2000:661–666.
Tfelt-Hansen P, McEwen J: Nonsteroidal antiinflammatory drugs in the acute treatment of migraine. In The Headaches, edn 2. Edited by Olsen J, Tfelt-Hansen P, Welch KMA. Philadelphia: Lippincott Williams and Wilkins; 2000:391–397.
Davis C, Torre P, Williams C: Ketorolac versus meperidine-plus-promethazine treatment of migraine headache: evaluation by patients. Am J Emerg Med 1995, 13:146–150.
Ryan R: A study of midrin in the symptomatic relief of migraine headache. Headache 1974, 14:33–42.
Saxena PR, Tfelt-Hansen P: Triptans, 5-HT1B and 1D receptor agonists in the acute treatment of migraine. In The Headaches, edn 2. Edited by Olsen J, Tfelt-Hansen P, Welch KMA. Philadelphia: Lippincott Williams and Wilkins; 2000:411–438.
American Academy of Neurology: American Academy of Neurology Headache Guidelines. Accessed at: http://www.aan.org.
Gallagher R: Acute treatment of migraine with dihydroergotamine nasal spray. Arch Neurol 1996, 53:1285–1291.
Winner P, Ricalde O, Le Force B, et al.: A double-blind study of subcutaneous dihydroergotamine vs subcutaneous sumatriptan in the treatment of acute migraine. Arch Neurol 1996, 53:180–184.
Mc Beath J, Nanda A: Use of dihydroergotamine in patients with postconcussion syndrome. Headache 1994, 34:148–151.
Carlsson J, Jensen R: Physiotherapy of tension-type headache. In The Headaches, 2nd ed. Edited by: Olsen J, Tfelt-Hansen P, Welch KMA. Philadelphia: Lippincott Williams and Wilkins; 2000:651–656.
Packard RC: Epidemiology and pathogenesis of post-traumatic headache. J Head Trauma Rehabil 1999, 14:9–21.
Hickling E, Blanchard E, Silverman D, Schwarz S: Motor vehicle accidents, headaches and post-traumatic stress disorder: assessment and findings in a consecutive series. Headache 1992, 32:147–151.
Wheeler A: Botulinum toxin A adjunctive therapy for refractory headache associated with pericranial muscle tension. Headache 1998, 38:468–471.
Schulte-Mattler W, Wiesler T, Zierz S: Treatment of tension type headache with botulinum toxin: a pilot study. Eur J Med Res 1999, 4:183–186.
Carruthers A, Langtry J, Robinson G: Improvement of tension-type headache when treating wrinkles with botulinum toxin A injections. Headache 1999, 39:662–665.
Freund B, Schwartz M: Treatment of chronic cervicalassociated headache with botulinum toxin A: a pilot study. Headache 2000, 40:231–236.
Rollnik J, Tanneberger O, Schubert M, Schneider U, Dengler R: Treatment of tension-type headache with botulinum toxin A: a double-blind, placebocontrolled study. Headache 2000, 40:300–305.
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Lane, J.C., Arciniegas, D.B. Post-traumatic headache. Curr Treat Options Neurol 4, 89–104 (2002). https://doi.org/10.1007/s11940-002-0007-3
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DOI: https://doi.org/10.1007/s11940-002-0007-3