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What are the features of posttraumatic headaches (PTH)
Headaches occur in 30% to 90% of those symptomatic after mild traumatic brain injury.
The prevalence and lifetime duration are greater in those who have mild head injury compared with those who have more severe injury.
According to ICHD-3, the onset should be within 7 days of trauma or injury or within 7 days of regaining consciousness and/or the ability to sense and report pain when these abilities have been lost.
In most civilian studies, migraine-type headaches occur in about 25% while in US military series after blast trauma, migraine type is reported by about 75%. In one study of PTH in athletes, migraine type was reported by 18%.
The other headaches are predominantly tension type. PTH can also be due to occipital neuralgia, supra- and infraorbital neuralgia, scalp lacerations, and temporomandibular disorder.
Rare causes include TACs, CSF leaks through a cribiform plate fracture, cervical arterial dissections, cerebral venous thrombosis, and carotid-cavernous fistula. Of course, subdural and epidural hematomas should be excluded.
What are the prognosis and treatment of posttraumatic headaches (PTH) ?
Persistent headaches are reported at
- 3 months in 47% to 78%,
- 1 year in 8.4% to 35%,
- 4 years in 24%.
There are few randomized, placebo-controlled trials of medications. The headaches are treated like the primary headache it most resembles.
