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The Journal of Headache and Pain
Published in: The Journal of Headache and Pain 1/2020

Open Access 01-12-2020 | Central Nervous System Trauma | Review article

Persistent post-traumatic headache: a migrainous loop or not? The clinical evidence

Authors: Alejandro Labastida-Ramírez, Silvia Benemei, Maria Albanese, Antonina D’Amico, Giovanni Grillo, Oxana Grosu, Devrimsel Harika Ertem, Jasper Mecklenburg, Elena Petrovna Fedorova, Pavel Řehulka, Francesca Schiano di Cola, Javier Trigo Lopez, Nina Vashchenko, Antoinette MaassenVanDenBrink, Paolo Martelletti, On behalf of the European Headache Federation School of Advanced Studies (EHF-SAS)

Published in: The Journal of Headache and Pain | Issue 1/2020

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Abstract

Background

Headache is a common complication of traumatic brain injury. The International Headache Society defines post-traumatic headache as a secondary headache attributed to trauma or injury to the head that develops within seven days following trauma. Acute post-traumatic headache resolves after 3 months, but persistent post-traumatic headache usually lasts much longer and accounts for 4% of all secondary headache disorders.

Main body

The clinical features of post-traumatic headache after traumatic brain injury resemble various types of primary headaches and the most frequent are migraine-like or tension-type-like phenotypes. The neuroimaging studies that have compared persistent post-traumatic headache and migraine found different structural and functional brain changes, although migraine and post-traumatic headache may be clinically similar. Therapy of various clinical phenotypes of post-traumatic headache almost entirely mirrors the therapy of the corresponding primary headache and are currently based on expert opinion rather than scientific evidence. Pharmacologic therapies include both abortive and prophylactic agents with prophylaxis targeting comorbidities, especially impaired sleep and post-traumatic disorder. There are also effective options for non-pharmacologic therapy of post-traumatic headache, including cognitive-behavioral approaches, onabotulinum toxin injections, life-style considerations, etc.

Conclusion

Notwithstanding some phenotypic similarities, persistent post-traumatic headache after traumatic brain injury, is considered a separate phenomenon from migraine but available data is inconclusive. High-quality studies are further required to investigate the pathophysiological mechanisms of this secondary headache, in order to identify new targets for treatment and to prevent disability.
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Metadata
Title
Persistent post-traumatic headache: a migrainous loop or not? The clinical evidence
Authors
Alejandro Labastida-Ramírez
Silvia Benemei
Maria Albanese
Antonina D’Amico
Giovanni Grillo
Oxana Grosu
Devrimsel Harika Ertem
Jasper Mecklenburg
Elena Petrovna Fedorova
Pavel Řehulka
Francesca Schiano di Cola
Javier Trigo Lopez
Nina Vashchenko
Antoinette MaassenVanDenBrink
Paolo Martelletti
On behalf of the European Headache Federation School of Advanced Studies (EHF-SAS)
Publication date
01-12-2020
Publisher
Springer Milan
Published in
The Journal of Headache and Pain / Issue 1/2020
Print ISSN: 1129-2369
Electronic ISSN: 1129-2377
DOI
https://doi.org/10.1186/s10194-020-01122-5

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