Publication details

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

Authors

LABASTIDA-RAMIREZ Alejandro BENEMEI Silvia ALBANESE Maria AMICO Antonina GRILLO Giovanni GROSU Oxana ERTEM Harika MECKLENBURG Jasper FEDOROVA Elena Petrovna ŘEHULKA Pavel DI COLA Francesca Schiano LOPEZ Javier Trigo VASHCHENKO Nina MAASSENVANDENBRINK Antoinette MARTELLETTI Paolo

Year of publication 2020
Type Article in Periodical
Magazine / Source JOURNAL OF HEADACHE AND PAIN
MU Faculty or unit

Faculty of Medicine

Citation
Web https://thejournalofheadacheandpain.biomedcentral.com/track/pdf/10.1186/s10194-020-01122-5
Doi http://dx.doi.org/10.1186/s10194-020-01122-5
Keywords Headache; Migraine; Trauma; Traumatic brain injury; Treatment
Description 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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