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Semin Neurol 2018; 38(06): 619-626
DOI: 10.1055/s-0038-1673692
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Posttraumatic Headache

Brigid Dwyer
1   Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
2   Brain Injury Program, HealthSouth Braintree Rehabilitation Hospital, Braintree, Massachusetts
› Author Affiliations
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Publication History

Publication Date:
06 December 2018 (online)

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Abstract

Posttraumatic headaches are among the most challenging complaints after mild traumatic brain injury (mTBI). They are a debilitating problem experienced by patients after TBI of all severities. Up to 90% of mild TBI patients experience headache, particularly if female and with a premorbid history of primary headache. Tension headache has classically been the most common subtype, but in military populations migraine has dominated. Posttraumatic headache encompasses a spectrum of headache types that overlap heavily with common primary headache disorders, but also autonomic cephalgias as well as several secondary headache conditions. It is important to understand the evolution of postconcussion syndrome as a concept, and the challenges associated with diagnosing and treating multidomain drivers effectively. The first-line treatments for posttraumatic headache are typically the same as those used in nontraumatic headache, with additional considerations for cognitive side effects, posttraumatic epilepsy, and coexisting injuries resulting in neuropathic pain or medication overuse.

Keywords

Posttraumatic Headache - concussive headache - postconcussion syndrome - posttraumatic disorder
 

  • References

  • 1 Faul MXL, Wald MM, Coronado VG. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002–2006. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010
    Google Scholar
  • 2 Zaloshnja E, Miller T, Langlois JA, Selassie AW. Prevalence of long-term disability from traumatic brain injury in the civilian population of the United States, 2005. J Head Trauma Rehabil 2008; 23 (06) 394-400
    CrossrefPubMedGoogle Scholar
  • 3 Faux S, Sheedy J. A prospective controlled study in the prevalence of posttraumatic headache following mild traumatic brain injury. Pain Med 2008; 9 (08) 1001-1011
    CrossrefPubMedGoogle Scholar
  • 4 Kraus J, Schaffer K, Ayers K, Stenehjem J, Shen H, Afifi AA. Physical complaints, medical service use, and social and employment changes following mild traumatic brain injury: a 6-month longitudinal study. J Head Trauma Rehabil 2005; 20 (03) 239-256
    CrossrefPubMedGoogle Scholar
  • 5 Ottochian M, Salim A, Berry C, Chan LS, Wilson MT, Margulies DR. Severe traumatic brain injury: is there a gender difference in mortality?. Am J Surg 2009; 197 (02) 155-158
    CrossrefPubMedGoogle Scholar
  • 6 Ponsford JL, Myles PS, Cooper DJ. , et al. Gender differences in outcome in patients with hypotension and severe traumatic brain injury. Injury 2008; 39 (01) 67-76
    PubMedGoogle Scholar
  • 7 Boto GR, Gómez PA, De la Cruz J, Lobato RD. A historical analysis of severe head injury. Neurosurg Rev 2009; 32 (03) 343-353 , discussion 353–354
    CrossrefPubMedGoogle Scholar
  • 8 Hoffman JM, Lucas S, Dikmen S. , et al. Natural history of headache after traumatic brain injury. J Neurotrauma 2011; 28 (09) 1719-1725
    CrossrefPubMedGoogle Scholar
  • 9 Nicholson K, Martelli MF. The problem of pain. J Head Trauma Rehabil 2004; 19 (01) 2-9
    CrossrefPubMedGoogle Scholar
  • 10 Lew HL, Lin PH, Fuh JL, Wang SJ, Clark DJ, Walker WC. Characteristics and treatment of headache after traumatic brain injury: a focused review. Am J Phys Med Rehabil 2006; 85 (07) 619-627
    CrossrefPubMedGoogle Scholar
  • 11 Levin HS, Mattis S, Ruff RM. , et al. Neurobehavioral outcome following minor head injury: a three-center study. J Neurosurg 1987; 66 (02) 234-243
    CrossrefPubMedGoogle Scholar
  • 12 Dikmen S, Machamer J, Fann JR, Temkin NR. Rates of symptom reporting following traumatic brain injury. J Int Neuropsychol Soc 2010; 16 (03) 401-411
    CrossrefPubMedGoogle Scholar
  • 13 Sosin DM, Sniezek JE, Thurman DJ. Incidence of mild and moderate brain injury in the United States, 1991. Brain Inj 1996; 10 (01) 47-54
    CrossrefPubMedGoogle Scholar
  • 14 Packard RC. Epidemiology and pathogenesis of posttraumatic headache. J Head Trauma Rehabil 1999; 14 (01) 9-21
    CrossrefPubMedGoogle Scholar
  • 15 Zafonte RD, Horn LJ. Clinical assessment of posttraumatic headaches. J Head Trauma Rehabil 1999; 14 (01) 22-33
    CrossrefPubMedGoogle Scholar
  • 16 Hecht JS. Occipital nerve blocks in postconcussive headaches: a retrospective review and report of ten patients. J Head Trauma Rehabil 2004; 19 (01) 58-71
    CrossrefPubMedGoogle Scholar
  • 17 Theeler BJ, Flynn FG, Erickson JC. Headaches after concussion in US soldiers returning from Iraq or Afghanistan. Headache 2010; 50 (08) 1262-1272
    CrossrefPubMedGoogle Scholar
  • 18 Haas DC. Chronic post-traumatic headaches classified and compared with natural headaches. Cephalalgia 1996; 16 (07) 486-493
    CrossrefPubMedGoogle Scholar
  • 19 Lucas S, Blume HK. Sport-related headache. Neurol Clin 2017; 35 (03) 501-521
    CrossrefPubMedGoogle Scholar
  • 20 Couch JR, Bearss C. Chronic daily headache in the posttrauma syndrome: relation to extent of head injury. Headache 2001; 41 (06) 559-564
    CrossrefPubMedGoogle Scholar
  • 21 Jacob S, Saha A, Rajabally Y. Post-traumatic short-lasting unilateral headache with cranial autonomic symptoms (SUNA). Cephalalgia 2008; 28 (09) 991-993
    CrossrefPubMedGoogle Scholar
  • 22 Matharu MJ, Goadsby PJ. Post-traumatic chronic paroxysmal hemicrania (CPH) with aura. Neurology 2001; 56 (02) 273-275
    CrossrefPubMedGoogle Scholar
  • 23 Putzki N, Nirkko A, Diener HC. Trigeminal autonomic cephalalgias: a case of post-traumatic SUNCT syndrome?. Cephalalgia 2005; 25 (05) 395-397
    CrossrefPubMedGoogle Scholar
  • 24 Packard RC, Hamm LP. Incidence of cluster-like post-traumatic headache: an inconsistency. Headache Quarterly 1996; 7: 139-141
    PubMedGoogle Scholar
  • 25 Evans RW. The postconcussion syndrome and the sequelae of mild head injury. Neurol Clin 1992; 10 (04) 815-847
    CrossrefPubMedGoogle Scholar
  • 26 Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33 (09) 629-808
    CrossrefPubMedGoogle Scholar
  • 27 Couch JR, Lipton R, Stewart WF. Is post-traumatic headache classifiable and does it exist?. Eur J Neurol 2009; 16 (01) 12-13
    PubMedGoogle Scholar
  • 28 Burke JP, Marion DW. Cerebral revascularization in trauma and carotid occlusion. Neurosurg Clin N Am 2001; 12 (03) 595-611 , ix
    CrossrefPubMedGoogle Scholar
  • 29 Siavoshi S, Dougherty C, Ailani J, Yadwadkar K, Berkowitz F. An unusual case of post-traumatic headache complicated by intracranial hypotension. Brain Sci 2016; 7 (01) E3
    CrossrefPubMedGoogle Scholar
  • 30 Mokri B. Spontaneous CSF leaks: low CSF volume syndromes. Neurol Clin 2014; 32 (02) 397-422
    CrossrefPubMedGoogle Scholar
  • 31 Samii C, Möbius E, Weber W, Heienbrok HW, Berlit P. Pseudo Chiari type I malformation secondary to cerebrospinal fluid leakage. J Neurol 1999; 246 (03) 162-164
    CrossrefPubMedGoogle Scholar
  • 32 Zasler ND. Posttraumatic tension pneumocephalus. J Head Trauma Rehabil 1999; 14 (01) 81-84
    CrossrefPubMedGoogle Scholar
  • 33 Donovan DJ, Iskandar JI, Dunn CJ, King JA. Aeromedical evacuation of patients with pneumocephalus: outcomes in 21 cases. Aviat Space Environ Med 2008; 79 (01) 30-35
    CrossrefPubMedGoogle Scholar
  • 34 Illingworth R, Shawdon H. Conservative management of intracranial extradural haematoma presenting late. J Neurol Neurosurg Psychiatry 1983; 46 (06) 558-560
    CrossrefPubMedGoogle Scholar
  • 35 Jamieson KG, Yelland JDN. Extradural hematoma. Report of 167 cases. J Neurosurg 1968; 29 (01) 13-23
    CrossrefPubMedGoogle Scholar
  • 36 Zasler ND, Martelli MF. Post-traumatic headache: practical approaches to diagnosis and treatment. In: Weiner RB. , ed. Pain Management: A Practical Guide for Clinicians. 6th ed. Boca Raton, FL: St. Lucie Press; 2002: 313-344
    Google Scholar
  • 37 Swartz R, Longwell P. Treatment of vertigo. Am Fam Physician 2005; 71 (06) 1115-1122
    PubMedGoogle Scholar
  • 38 Horn LJ, Siebert B, Patel N. et al. Headache. In: Zasler ND, Katz DI, Zafonte RD. , eds. Brain Injury Medicine. 3rd ed. New York, NY: Demos Medical Publishing; 2013: 932-953
    Google Scholar
  • 39 Arendt-Nielsen L, Laursen RJ, Drewes AM. Referred pain as an indicator for neural plasticity. Prog Brain Res 2000; 129: 343-356
    PubMedGoogle Scholar
  • 40 Shepard N, Handelsman JA, Clendaniel RA. Balance and dizziness. In: Katz D, Zasler ND, Zafonte RD. , ed. Brain Injury Medicine. 3rd ed. New York, NY: Demos Medical Publishing; 2013
    Google Scholar
  • 41 Leddy JJ, Baker JG, Kozlowski K, Bisson L, Willer B. Reliability of a graded exercise test for assessing recovery from concussion. Clin J Sport Med 2011; 21 (02) 89-94
    CrossrefPubMedGoogle Scholar
  • 42 Guskiewicz KM. Postural stability assessment following concussion: one piece of the puzzle. Clin J Sport Med 2001; 11 (03) 182-189
    CrossrefPubMedGoogle Scholar
  • 43 Galetta MS, Galetta KM, McCrossin J. , et al. Saccades and memory: baseline associations of the King-Devick and SCAT2 SAC tests in professional ice hockey players. J Neurol Sci 2013; 328 (1-2): 28-31
    CrossrefPubMedGoogle Scholar
  • 44 Morgan CD, Zuckerman SL, King LE, Beaird SE, Sills AK, Solomon GS. Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging. Childs Nerv Syst 2015; 31 (12) 2305-2309
    CrossrefPubMedGoogle Scholar
  • 45 Ruff RL, Blake K. Pathophysiological links between traumatic brain injury and post-traumatic headaches. F1000 Res 2016; 5: F1000
    CrossrefPubMedGoogle Scholar
  • 46 Ponsford J, Willmott C, Rothwell A. , et al. Factors influencing outcome following mild traumatic brain injury in adults. J Int Neuropsychol Soc 2000; 6 (05) 568-579
    CrossrefPubMedGoogle Scholar
  • 47 Rohling ML, Binder LM, Demakis GJ, Larrabee GJ, Ploetz DM, Langhinrichsen-Rohling J. A meta-analysis of neuropsychological outcome after mild traumatic brain injury: re-analyses and reconsiderations of Binder et al. (1997), Frencham et al. (2005), and Pertab et al. (2009). Clin Neuropsychol 2011; 25 (04) 608-623
    CrossrefPubMedGoogle Scholar
  • 48 Walker WC, Seel RT, Curtiss G, Warden DL. Headache after moderate and severe traumatic brain injury: a longitudinal analysis. Arch Phys Med Rehabil 2005; 86 (09) 1793-1800
    CrossrefPubMedGoogle Scholar
  • 49 Organization WH. International Statistical Classification of Diseases and Related Health Problems, 10th ed. Geneva, Switzerland: World Health Organization; 1992
    Google Scholar
  • 50 Association AP. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association; 2000
    Google Scholar
  • 51 Association AP. The Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA: American Psychiatric Association; 2013
    Google Scholar
  • 52 McCrory P, Meeuwisse W, Dvořák J. , et al. Consensus statement on concussion in sport-the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med 2017; 51 (11) 838-847
    PubMedGoogle Scholar
  • 53 Ellis MJ, Leddy J, Willer B. Multi-disciplinary management of athletes with post-concussion syndrome: an evolving pathophysiological approach. Front Neurol 2016; 7: 136
    PubMedGoogle Scholar
  • 54 Asplund CA, McKeag DB, Olsen CH. Sport-related concussion: factors associated with prolonged return to play. Clin J Sport Med 2004; 14 (06) 339-343
    CrossrefPubMedGoogle Scholar
  • 55 Collins MW, Field M, Lovell MR. , et al. Relationship between postconcussion headache and neuropsychological test performance in high school athletes. Am J Sports Med 2003; 31 (02) 168-173
    CrossrefPubMedGoogle Scholar
  • 56 Mihalik JP, Stump JE, Collins MW, Lovell MR, Field M, Maroon JC. Posttraumatic migraine characteristics in athletes following sports-related concussion. J Neurosurg 2005; 102 (05) 850-855
    CrossrefPubMedGoogle Scholar
  • 57 Savola O, Hillbom M. Early predictors of post-concussion symptoms in patients with mild head injury. Eur J Neurol 2003; 10 (02) 175-181
    CrossrefPubMedGoogle Scholar
  • 58 De Kruijk JR, Leffers P, Menheere PP, Meerhoff S, Rutten J, Twijnstra A. Prediction of post-traumatic complaints after mild traumatic brain injury: early symptoms and biochemical markers. J Neurol Neurosurg Psychiatry 2002; 73 (06) 727-732
    CrossrefPubMedGoogle Scholar
  • 59 Giza CC, Kutcher JS, Ashwal S. , et al. Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2013; 80 (24) 2250-2257
    CrossrefPubMedGoogle Scholar
  • 60 Dischinger PC, Ryb GE, Kufera JA, Auman KM. Early predictors of postconcussive syndrome in a population of trauma patients with mild traumatic brain injury. J Trauma 2009; 66 (02) 289-296 , discussion 296–297
    CrossrefPubMedGoogle Scholar
  • 61 Greiffenstein FM, Baker JW. Comparison of premorbid and postinjury mmpi-2 profiles in late postconcussion claimants. Clin Neuropsychol 2001; 15 (02) 162-170
    CrossrefPubMedGoogle Scholar
  • 62 Mooney G, Speed J. The association between mild traumatic brain injury and psychiatric conditions. Brain Inj 2001; 15 (10) 865-877
    CrossrefPubMedGoogle Scholar
  • 63 Meares S, Shores EA, Taylor AJ. , et al. The prospective course of postconcussion syndrome: the role of mild traumatic brain injury. Neuropsychology 2011; 25 (04) 454-465
    CrossrefPubMedGoogle Scholar
  • 64 Evered L, Ruff R, Baldo J, Isomura A. Emotional risk factors and postconcussional disorder. Assessment 2003; 10 (04) 420-427
    CrossrefPubMedGoogle Scholar
  • 65 Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA. Mild traumatic brain injury in U.S. Soldiers returning from Iraq. N Engl J Med 2008; 358 (05) 453-463
    CrossrefPubMedGoogle Scholar
  • 66 Kashluba S, Paniak C, Casey JE. Persistent symptoms associated with factors identified by the WHO Task Force on Mild Traumatic Brain Injury. Clin Neuropsychol 2008; 22 (02) 195-208
    CrossrefPubMedGoogle Scholar
  • 67 Tiersky LA, Anselmi V, Johnston MV. , et al. A trial of neuropsychologic rehabilitation in mild-spectrum traumatic brain injury. Arch Phys Med Rehabil 2005; 86 (08) 1565-1574
    CrossrefPubMedGoogle Scholar
  • 68 Rutherford WH, Merrett JD, McDonald JR. Symptoms at one year following concussion from minor head injuries. Injury 1979; 10 (03) 225-230
    CrossrefPubMedGoogle Scholar
  • 69 Cartlidge NE, Shaw DA. Head Injury. London, UK: WB Saunders; 1981
    Google Scholar
  • 70 Dikmen S, Machamer J, Temkin N. Mild traumatic brain injury: longitudinal study of cognition, functional status, and post-traumatic symptoms. J Neurotrauma 2017; 34 (08) 1524-1530
    CrossrefPubMedGoogle Scholar
  • 71 Kashluba S, Paniak C, Blake T, Reynolds S, Toller-Lobe G, Nagy J. A longitudinal, controlled study of patient complaints following treated mild traumatic brain injury. Arch Clin Neuropsychol 2004; 19 (06) 805-816
    CrossrefPubMedGoogle Scholar
  • 72 Barker MJ, Greenwood KM, Jackson M, Crowe SF. Persistence of cognitive effects after withdrawal from long-term benzodiazepine use: a meta-analysis. Arch Clin Neuropsychol 2004; 19 (03) 437-454
    CrossrefPubMedGoogle Scholar
  • 73 Barker MJ, Greenwood KM, Jackson M, Crowe SF. An evaluation of persisting cognitive effects after withdrawal from long-term benzodiazepine use. J Int Neuropsychol Soc 2005; 11 (03) 281-289
    CrossrefPubMedGoogle Scholar
  • 74 Patil VK, St Andre JR, Crisan E. , et al. Prevalence and treatment of headaches in veterans with mild traumatic brain injury. Headache 2011; 51 (07) 1112-1121
    CrossrefPubMedGoogle Scholar
  • 75 Diamond S, Baltes BJ. Chronic tension headache--treated with amitriptyline--a double-blind study. Headache 1971; 11 (03) 110-116
    CrossrefPubMedGoogle Scholar
  • 76 Bendtsen L, Buchgreitz L, Ashina S, Jensen R. Combination of low-dose mirtazapine and ibuprofen for prophylaxis of chronic tension-type headache. Eur J Neurol 2007; 14 (02) 187-193
    CrossrefPubMedGoogle Scholar
  • 77 Krishnan A, Silver N. Headache (chronic tension-type). BMJ Clin Evid 2009; 2009: 1205
    PubMedGoogle Scholar
  • 78 Silberstein SD. Preventive migraine treatment. Continuum (Minneap Minn) 2015; 21 (4 Headache): 973-989
    PubMedGoogle Scholar
  • 79 Schiapparelli P, Allais G, Castagnoli Gabellari I, Rolando S, Terzi MG, Benedetto C. Non-pharmacological approach to migraine prophylaxis: part II. Neurol Sci 2010; 31 (Suppl. 01) S137-S139
    PubMedGoogle Scholar
  • 80 Leddy JJ, Willer B. Use of graded exercise testing in concussion and return-to-activity management. Curr Sports Med Rep 2013; 12 (06) 370-376
    CrossrefPubMedGoogle Scholar
  • 81 Baker JG, Freitas MS, Leddy JJ, Kozlowski KF, Willer BS. Return to full functioning after graded exercise assessment and progressive exercise treatment of postconcussion syndrome. Rehabil Res Pract 2012; 2012: 705309
    PubMedGoogle Scholar
  • 82 Shekleton JA, Parcell DL, Redman JR, Phipps-Nelson J, Ponsford JL, Rajaratnam SM. Sleep disturbance and melatonin levels following traumatic brain injury. Neurology 2010; 74 (21) 1732-1738
    CrossrefPubMedGoogle Scholar
  • 83 Castriotta RJ, Wilde MC, Lai JM, Atanasov S, Masel BE, Kuna ST. Prevalence and consequences of sleep disorders in traumatic brain injury. J Clin Sleep Med 2007; 3 (04) 349-356
    PubMedGoogle Scholar
  • 84 Lautenbacher S, Kundermann B, Krieg JC. Sleep deprivation and pain perception. Sleep Med Rev 2006; 10 (05) 357-369
    CrossrefPubMedGoogle Scholar
  • 85 Gladstone J. From psychoneurosis to ICHD-2: an overview of the state of the art in post-traumatic headache. Headache 2009; 49 (07) 1097-1111
    CrossrefPubMedGoogle Scholar
  • 86 Ponsford J, Tweedly L, Taffe J. The relationship between alcohol and cognitive functioning following traumatic brain injury. J Clin Exp Neuropsychol 2013; 35 (01) 103-112
    CrossrefPubMedGoogle Scholar
  • 87 Corrigan JD. Substance abuse as a mediating factor in outcome from traumatic brain injury. Arch Phys Med Rehabil 1995; 76 (04) 302-309
    CrossrefPubMedGoogle Scholar
  • 88 Sander AM, Witol AD, Kreutzer JS. Alcohol use after traumatic brain injury: concordance of patients' and relatives' reports. Arch Phys Med Rehabil 1997; 78 (02) 138-142
    CrossrefPubMedGoogle Scholar
  • 89 Bombardier CH, Rimmele CT, Zintel H. The magnitude and correlates of alcohol and drug use before traumatic brain injury. Arch Phys Med Rehabil 2002; 83 (12) 1765-1773
    CrossrefPubMedGoogle Scholar
  • 90 Parry-Jones BL, Vaughan FL, Miles Cox W. Traumatic brain injury and substance misuse: a systematic review of prevalence and outcomes research (1994-2004). Neuropsychol Rehabil 2006; 16 (05) 537-560
    CrossrefPubMedGoogle Scholar