79 results on '"Posttraumatic headache"'
Search Results
2. Reason to doubt the ICHD-3 7-day inclusion criterion for mild TBI-related posttraumatic headache: A nested cohort study
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David E. Reed, Carlos A. Jaramillo, Blessen C. Eapen, Donald D. McGeary, Timothy T. Houle, Terence M. Keane, Alan L. Peterson, Jason J. Sico, Donald B. Penzien, Sanjog Pangarkar, Patricia A. Resick, Cindy A. McGeary, Paul S Nabity, John C. Moring, and Stacey Young-McCaughan
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Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Time Factors ,Inclusion (disability rights) ,Injury control ,Poison control ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,International Classification of Diseases ,Injury prevention ,medicine ,Humans ,030212 general & internal medicine ,Limited evidence ,Posttraumatic headache ,Brain Concussion ,Randomized Controlled Trials as Topic ,Veterans ,business.industry ,Head injury ,General Medicine ,Middle Aged ,medicine.disease ,Post-Traumatic Headache ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Cohort study - Abstract
Background Posttraumatic headache is difficult to define and there is debate about the specificity of the 7-day headache onset criterion in the current definition. There is limited evidence available to guide decision making about this criterion. Method A nested cohort study of 193 treatment-seeking veterans who met criteria for persistent headache attributed to mild traumatic injury to the head, including some veterans with delayed headache onset up to 90 days post-injury, was undertaken. Survival analysis examined the proportion of participants reporting headache over time and differences in these proportions based on sex, headache phenotype, and mechanism of injury. Result 127 participants (66%; 95% CI: 59–72%) reported headache onset within 7 days of head injury and 65 (34%) reported headache onset between 8 days and 3 months after head injury. Fourteen percent of participants reported pre-existing migraine before head injury, and there was no difference in the proportion of veterans with pre-existing migraine based on headache onset. Headache onset times were not associated with sex, headache phenotype, or mechanism of injury. There were no significant differences in proportion of veterans with headache onset within 7 days of head injury based on headache phenotype (70% migraine onset within 7 days, 70% tension-type headache within 7 days, 56% cluster headache within 7 days; p ≥ .364). Similar findings were observed for head injury (64% blast, 60% blunt; p = .973). There were no significant differences observed between headache onset groups for psychiatric symptoms (Posttraumatic Stress Disorder Checklist for DSM-5 = 1.3, 95% CI = −27.5, 30.1; Patient Health Questionnaire-9 Item = 3.5, 95% CI = −6.3, 3.7; Generalized Anxiety Disorder Screener = 6.5, 95% CI = −2.7, 15.6). Conclusions Although most of the sample reported headache onset within 7 days of head injury, one-third experienced an onset outside of the diagnostic range. Additionally, veterans with headache onset within 7 days of head injury were not meaningfully different from those with later onset based on sex, headache phenotype, or mechanism of head injury. The ICHD-3 diagnostic criteria for 7-day headache onset should be expanded to 3 months. ClinicalTrials.gov Identifier NCT02419131
- Published
- 2020
3. Characteristics of a headache on patients with mild traumatic brain injury: Implications for improving nurse practice
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Ivana Dondo, Milica Domazet, Dragana Simin, and Jovana Božičić
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medicine.medical_specialty ,business.industry ,Traumatic brain injury ,nurse ,RT1-120 ,030208 emergency & critical care medicine ,Nursing ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,mild traumatic brain injury ,posttraumatic headache ,Physical therapy ,Medicine ,pain ,business ,030217 neurology & neurosurgery - Abstract
Introduction: Headache is one of the most frequent reported symptom after mild traumatic brain injury and it affects normal functioning and life as a whole. The goal: The goal is the evaluation of access, the quality and characteristics of the headache which occurs after the mild traumatic brain injury. Material and methods: The research has been done as a study section in the clinical center of Vojvodina, in the neurosurgery section. A survey questionnaire constructed for the purposes of this research was used as a research instrument. The survey questionnaire included twenty-one questions.. The norm for including respondents in the research was for them to be hospitalized patients with mild traumatic brain injury and the norm for determining how bad the injury was Glazgow's coma score was used. For determining the intensity of the headache the numeric pain rate scale from zero to ten was used. Results: The posttraumatic headache was present in all patients. Most of the respondents described the headache as dull pain of high intensity, 50% of them said that the headache is disturbing them while doing everyday activities and that the intensity of the pain is worst in the morning than at night. Also, some reported that bright light, thinking and talking increase the pain level. Conclusion: The data from this study indicate that headaches in patients after mild TBI can be a major problem in terms of their functional abilities. Thus, the primary focus of nurses should be on early detection and relief of these symptoms. We can also view this study as an initial step, which can affect nurses' practice, and thus the well-being of patients and society as a whole.
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- 2020
4. Clinical Experiences with Repetitive Neuromuscular Magnetic Stimulation in Children with Posttraumatic Headache: A Retrospective Study
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Florian Heinen, M. Lang, A. Hauser, C. Göttler, J. Staisch, Michaela Bonfert, J. Wagner, and Corinna Börner
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medicine.medical_specialty ,business.industry ,Physical therapy ,Medicine ,Retrospective cohort study ,Stimulation ,business ,Posttraumatic headache - Published
- 2021
5. Somatosensory dysfunction in patients with posttraumatic headache: A systematic review
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Martin Tegenthoff, Özüm Simal Özgül, Oliver Höffken, Peter Schwenkreis, Elena K. Enax-Krumova, and Julia Jessen
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medicine.medical_specialty ,Traumatic brain injury ,business.industry ,Quantitative sensory testing ,Headache ,Pain ,General Medicine ,medicine.disease ,Somatosensory system ,Somatosensory function ,Sensory function ,Physical medicine and rehabilitation ,Conditioned pain modulation ,Brain Injuries, Traumatic ,medicine ,Quality of Life ,Humans ,Post-Traumatic Headache ,In patient ,Neurology (clinical) ,business ,Posttraumatic headache - Abstract
Objectives Aim of the review is to summarize the knowledge about the sensory function and pain modulatory systems in posttraumatic headache and discuss its possible role in patients with posttraumatic headache. Background Posttraumatic headache is the most common complication after traumatic brain injury, and significantly impacts patients’ quality of life. Even though it has a high prevalence, its origin and pathophysiology are poorly understood. Thereby, the existing treatment options are insufficient. Identifying its mechanisms can be an important step forward to develop target-based personalized treatment. Methods We searched the PubMed database for studies examining pain modulation and/or quantitative sensory testing in individuals with headache after brain injury. Results The studies showed heterogenous alterations in sensory profiles (especially in heat and pressure pain perception) compared to healthy controls and headache-free traumatic brain injury-patients. Furthermore, pain inhibition capacity was found to be diminished in subjects with posttraumatic headache. Conclusions Due to the small number of heterogenous studies a distinct sensory pattern for patients with posttraumatic headache could not be identified. Further research is needed to clarify the underlying mechanisms and biomarkers for prediction of development and persistence of posttraumatic headache.
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- 2021
6. The road taken
- Author
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Alan G. Finkel
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medicine.medical_specialty ,business.industry ,medicine.disease ,Blast injury ,Neurology ,Blast Injuries ,Emergency medicine ,Brain Injuries, Traumatic ,medicine ,Humans ,Post-Traumatic Headache ,Neurology (clinical) ,business ,Posttraumatic headache ,Veterans - Published
- 2021
7. Recurrent activity-induced headache associated with posttraumatic dural adhesion of the middle meningeal artery: A case report
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Lee Elisevich, Meggen Walsh, and Justin Singer
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0303 health sciences ,Plexus ,business.industry ,Middle meningeal artery ,Adhesion (medicine) ,General Medicine ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Migraine ,Anesthesia ,medicine.artery ,Afferent ,medicine ,Neurology (clinical) ,business ,Posttraumatic headache ,030217 neurology & neurosurgery ,Epidural Hemorrhage ,030304 developmental biology - Abstract
Background The middle meningeal artery is surrounded by a plexus of afferent fibers shown to be involved in the progression of some forms of headache, especially migraine. Posttraumatic headache disorders sharing characteristics with migraine and involving the middle meningeal artery are not readily available in the literature. Case description This report describes a posttraumatic headache disorder in a middle-aged woman in which the causative factor proved to be a pathology of the left middle meningeal artery that resulted from trauma. Her pain could be triggered by moderate accelerative changes, occurring in the left frontotemporal region, and shared characteristics with migraine. Resection of a portion of the left middle meningeal artery has completely eliminated her pain syndrome. Conclusion This case further elucidates associations between the middle meningeal artery and headache. The presentation of posttraumatic headache sharing characteristics with migraine should suggest the possibility of a middle meningeal artery abnormality.
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- 2019
8. Study design for a randomized clinical trial of cognitive-behavioral therapy for posttraumatic headache
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Donald B. Penzien, Donald D. McGeary, Blessen C. Eapen, Alan L. Peterson, Cindy A. McGeary, Timothy T. Houle, Terence M. Keane, John C. Moring, Stacey Young-McCaughan, Carlos A. Jaramillo, Patricia A. Resick, and Paul S Nabity
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ICHD-3, International Classification of Headache Disorders, 3rd Edition ,PP, per protocol ,CAPS-5, Clinician-Administered PTSD Scale for DSM-5 ,medicine.medical_treatment ,Psychological intervention ,PHQ-15, Patient Health Questionnaire-15 ,PRC, Polytrauma Rehabilitation Center ,CGRP, calcitonin gene-related peptide ,VR-12, Veterans RAND 12-Item Health Survey ,law.invention ,PTCI, Posttraumatic Cognitions Inventory ,NIH, National Institutes of Health ,0302 clinical medicine ,Traumatic brain injury ,CEQ, Credibility and Expectancy Questionnaire ,DoD, U.S. Department of Defense ,SDIH-R, Structured Diagnostic Interview for Headache-Revised, Brief Version ,Randomized controlled trial ,law ,DSI-SS, Depressive Symptom Index-Suicide Subscale ,SITBI, Self-Injurious Thoughts and Behaviors Interview – Short Form ,030212 general & internal medicine ,Posttraumatic headache ,PTHA Study, posttraumatic headache and PTSD study ,Veterans ,TAU, treatment as usual ,lcsh:R5-920 ,HMSE, Headache Management Self-Efficacy Scale ,LEC-5, Life Events Checklist for DSM-5 ,Head injury ,Headache ,CPT, Cognitive Processing Therapy ,PTSD ,General Medicine ,DRRI-2-P, Deployment Risk and Resilience Inventory-Postbattle Experiences ,RSES, Response to Stressful Experiences Scale ,HIPAA, Health Insurance Portability and Accountability Act ,Cognitive behavioral therapy ,CAP, Consortium to Alleviate PTSD ,STOP, Snoring, Tired, Observed, Blood Pressure ,PTSD, posttraumatic stress disorder ,CCBT, clinic-based cognitive-behavioral therapy intervention for headache ,AUDIT, Alcohol Use Disorders Identification Test-Self Report ,Headaches ,medicine.symptom ,lcsh:Medicine (General) ,IRB, institutional review board ,ISI, Insomnia Severity Index ,medicine.medical_specialty ,QDS, Quick Drinking Screen ,VA, U.S. Department of Veterans Affairs ,DRRI-2-D, Deployment Risk and Resilience Inventory-2-Deployment Environment ,Article ,GAD-7, Generalized Anxiety Disorder Screener ,TBI, traumatic brain injury ,03 medical and health sciences ,HSLC, Headache-Specific Locus of Control Scale ,PHQ-9, Patient Health Questionnaire-9 Item ,medicine ,Balance (ability) ,ICHD-2, International Classification of Headache Disorders, 2nd Edition ,Pharmacology ,GLM, general linear mixed ,PCL-5, PTSD Checklist for DSM-5 ,CRIS, Community Reintegration of Injured Service Members ,business.industry ,PROMIS, Patient-Reported Outcomes Measurement Information System ,CBT, cognitive-behavioral therapy ,HIT-6, Headache Impact Test ,Polymorbidity ,medicine.disease ,VHCS, Veterans Health Care System ,NSI, Neurobehavioral Symptom Inventory ,B-IPF, Brief Inventory of Psychosocial Functioning ,CPRS, Computerized Patient Record System ,PTH, posttraumatic headache ,Physical therapy ,ITT, intent to treat ,OSU TBI-ID-SF, Ohio State University TBI Identification Method-Interview Form ,business ,030217 neurology & neurosurgery - Abstract
Posttraumatic headache (PTH) is a common debilitating condition arising from head injury and is highly prevalent among military service members and veterans with traumatic brain injury (TBI). Diagnosis and treatment for PTH is still evolving, and surprisingly little is known about the putative mechanisms that drive these headaches. This manuscript describes the design of a randomized clinical trial of two nonpharmacological (i.e., behavioral) interventions for posttraumatic headache. Design of this trial required careful consideration of PTH diagnosis and inclusion criteria, which was challenging due to the lack of standard clinical characteristics in PTH unique from other types of headaches. The treatments under study differed in clinical focus and dose (i.e., number of treatment sessions), but the trial was designed to balance the treatments as well as possible. Finally, while the primary endpoints for pain research can vary from assessments of pain intensity to objective and subjective functional measures, this trial of PTH interventions chose carefully to establish clinically relevant endpoints and to maximize the opportunity to detect significant differences between groups with two primary outcomes. All these issues are discussed in this manuscript.
- Published
- 2021
9. Identifying oxidized lipid mediators as prognostic biomarkers of chronic post-traumatic headache
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J. Douglas Mann, Daisy Zamora, Mark S. Horowitz, Anthony F. Domenichiello, Christopher E. Ramsden, Andrew J. Mannes, Keturah R. Faurot, Zhi-Xin Yuan, and Jennifer R. Jensen
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medicine.medical_specialty ,Docosahexaenoic Acids ,Traumatic brain injury ,Linoleic acid ,Article ,law.invention ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Randomized controlled trial ,030202 anesthesiology ,law ,Internal medicine ,medicine ,Humans ,Oxylipins ,Posttraumatic headache ,business.industry ,Headache ,medicine.disease ,Prognosis ,Anesthesiology and Pain Medicine ,Neurology ,chemistry ,Docosahexaenoic acid ,Arachidonic acid ,Neurology (clinical) ,Headaches ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Oxidized lipid ,Biomarkers - Abstract
Chronic posttraumatic headache (PTH) is among the most common and disabling sequelae of traumatic brain injury (TBI). Current PTH treatments are often only partially effective and have problematic side effects. We previously showed in a small randomized trial of patients with chronic nontraumatic headaches that manipulation of dietary fatty acids decreased headache frequency, severity, and pain medication use. Pain reduction was associated with alterations in oxylipins derived from n-3 and n-6 fatty acids, suggesting that oxylipins could potentially mediate clinical pain reduction. The objective of this study was to investigate whether circulating oxylipins measured in the acute setting after TBI could serve as prognostic biomarkers for developing chronic PTH. Participants enrolled in the Traumatic Head Injury Neuroimaging Classification Protocol provided serum within 3 days of TBI and were followed up at 90 days postinjury with a neurobehavioral symptom inventory (NSI) and satisfaction with life survey. Liquid chromatography-tandem mass spectrometry methods profiled 39 oxylipins derived from n-3 docosahexaenoic acid (DHA), and n-6 arachidonic acid and linoleic acid. Statistical analyses assessed the association of oxylipins with headache severity (primary outcome, measured by headache question on NSI) as well as associations between oxylipins and total NSI or satisfaction with life survey scores. Among oxylipins, 4-hydroxy-DHA and 19,20-epoxy-docosapentaenoate (DHA derivatives) were inversely associated with headache severity, and 11-hydroxy-9-epoxy-octadecenoate (a linoleic acid derivative) was positively associated with headache severity. These findings support a potential for DHA-derived oxylipins as prognostic biomarkers for development of chronic PTH.
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- 2020
10. The role of deficient pain modulatory systems in the development of persistent post-traumatic headaches following mild traumatic brain injury: an exploratory longitudinal study
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Christopher Carey, Ryan Overman, Jonathan M. Saxe, Kelly M. Naugle, Fletcher A. White, and Eric Evans
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Adult ,medicine.medical_specialty ,Longitudinal study ,Neurology ,Traumatic brain injury ,Pain medicine ,Pain ,lcsh:Medicine ,Pilot Projects ,Pain modulation ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Longitudinal Studies ,Prospective Studies ,Conditioned pain modulation ,030212 general & internal medicine ,Mild traumatic brain injury ,Pathological ,Brain Concussion ,Pain catastrophizing ,Depression (differential diagnoses) ,Posttraumatic headache ,business.industry ,lcsh:R ,Headache ,General Medicine ,medicine.disease ,Anesthesiology and Pain Medicine ,Anesthesia ,Post-Traumatic Headache ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Research Article - Abstract
Background Post-traumatic headache (PTH) is one of the most common and long-lasting symptoms following mild traumatic brain injury (TBI). However, the pathological mechanisms underlying the development of persistent PTH remain poorly understood. The primary purpose of this prospective pilot study was to evaluate whether early pain modulatory profiles (sensitization and endogenous pain inhibitory capacity) and psychological factors after mild TBI predict the development of persistent PTH in mild TBI patients. Methods Adult mild TBI patients recruited from Level I Emergency Department Trauma Centers completed study sessions at 1–2 weeks, 1-month, and 4-months post mild TBI. Participants completed the following outcome measures during each session: conditioned pain modulation to measure endogenous pain inhibitory capacity, temporal summation of pain and pressure pain thresholds of the head to measure sensitization of the head, Pain Catastrophizing Scale, Center for Epidemiological Studies – Depression Scale, and a standardized headache survey. Participants were classified into persistent PTH (PPTH) and no-PPTH groups based on the 4-month data. Results The results revealed that mild TBI patients developing persistent PTH exhibited significantly diminished pain inhibitory capacity, and greater depression and pain catastrophizing following injury compared to those who do not develop persistent PTH. Furthermore, logistic regression indicated that headache pain intensity at 1–2 weeks and pain inhibitory capacity on the conditioned pain modulation test at 1–2 weeks predicted persistent PTH classification at 4 months post injury. Conclusions Overall, the results suggested that persistent PTH is characterized by dysfunctional alterations in endogenous pain modulatory function and psychological processes in the early stages following mild TBI, which likely exacerbate risk for the maintenance of PTH.
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- 2020
11. Mild traumatic brain injury is associated with effect of inflammation on structural changes of default mode network in those developing chronic pain
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Xuan Niu, Xiaoyan Jia, Bo Yin, Yingxiang Sun, Hongjuan Liu, Guanghui Bai, Lijun Bai, Shuoqiu Gan, Yuan Wang, and Shan Wang
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medicine.medical_specialty ,Neurology ,Traumatic brain injury ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Mild traumatic brain injury ,Brain Concussion ,Anterior cingulate cortex ,Default mode network ,Posttraumatic headache ,030304 developmental biology ,Inflammation ,0303 health sciences ,business.industry ,Chronic pain ,Neuropsychology ,Default Mode Network ,General Medicine ,Voxel-based morphometry ,medicine.disease ,Inflammation effect ,Magnetic Resonance Imaging ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Posterior cingulate ,Quality of Life ,Neurology (clinical) ,Chronic Pain ,business ,030217 neurology & neurosurgery ,Research Article - Abstract
Background Mild traumatic brain injury (mTBI) has a higher prevalence (more than 50%) of developing chronic posttraumatic headache (CPTH) compared with moderate or severe TBI. However, the underlying neural mechanism for CPTH remains unclear. This study aimed to investigate the inflammation level and cortical volume changes in patients with acute PTH (APTH) and further examine their potential in identifying patients who finally developed CPTH at follow-up. Methods Seventy-seven mTBI patients initially underwent neuropsychological measurements, 9-plex panel of serum cytokines and MRI scans within 7 days post-injury (T-1) and 54 (70.1%) of patients completed the same protocol at a 3-month follow-up (T-2). Forty-two matched healthy controls completed the same protocol at T-1 once. Results At baseline, mTBI patients with APTH presented significantly increased GM volume mainly in the right dorsal anterior cingulate cortex (dACC) and dorsal posterior cingulate cortex (dPCC), of which the dPCC volume can predict much worse impact of headache on patients’ lives by HIT-6 (β = 0.389, P = 0.007) in acute stage. Serum levels of C-C motif chemokine ligand 2 (CCL2) were also elevated in these patients, and its effect on the impact of headache on quality of life was partially mediated by the dPCC volume (mean [SE] indirect effect, 0.088 [0.0462], 95% CI, 0.01–0.164). Longitudinal analysis showed that the dACC and dPCC volumes as well as CCL2 levels had persistently increased in patients developing CPTH 3 months postinjury. Conclusion The findings suggested that structural remodelling of DMN brain regions were involved in the progression from acute to chronic PTH following mTBI, which also mediated the effect of inflammation processes on pain modulation. Trial registration ClinicalTrial.gov ID: NCT02868684; registered 16 August 2016.
- Published
- 2020
12. Increased severity of closed head injury or repetitive subconcussive head impacts enhances post-traumatic headache-like behaviors in a rat model
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Dan Levy, Dara Bree, and Jennifer Stratton
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Male ,medicine.medical_specialty ,Head (linguistics) ,Calcitonin Gene-Related Peptide ,Rat model ,Calcitonin gene-related peptide ,Article ,Open field ,Head trauma ,Rats, Sprague-Dawley ,03 medical and health sciences ,Physical medicine and rehabilitation ,0302 clinical medicine ,Head Injuries, Closed ,Traumatic head injury ,Concussion ,Animals ,Medicine ,Posttraumatic headache ,030304 developmental biology ,0303 health sciences ,Thigmotaxis ,Behavior, Animal ,business.industry ,General Medicine ,medicine.disease ,Rats ,Peripheral ,Disease Models, Animal ,Anesthesia ,Closed head injury ,Hyperalgesia ,Post-Traumatic Headache ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Introduction Posttraumatic headache is one of the most common, debilitating, and difficult symptoms to manage after a traumatic head injury. The development of novel therapeutic approaches is nevertheless hampered by the paucity of preclinical models and poor understanding of the mechanisms underlying posttraumatic headache. To address these shortcomings, we previously characterized the development of posttraumatic headache-like pain behaviors in rats subjected to a single mild closed head injury using a 250 g weight drop. Here, we conducted a follow-up study to further extend the preclinical research toolbox for studying posttraumatic headache by exploring the development of headache-like pain behaviors in male rats subjected to a single, but more severe head trauma (450 g) as well as following repetitive, subconcussive head impacts (150 g). In addition, we tested whether these behaviors involve peripheral calcitonin gene-related peptide signaling by testing the effect of systemic treatment with an anti-calcitonin gene-related peptide monoclonal antibody (anti-calcitonin gene-related peptide mAb). Methods Adult male Sprague Dawley rats (total n = 138) were subjected to diffuse closed head injury using a weight-drop device, or a sham procedure. Three injury paradigms were employed: A single hit, using 450 g or 150 g weight drop, and three successive 150 g weight drop events conducted 72 hours apart. Changes in open field activity and development of cephalic and extracephalic tactile pain hypersensitivity were assessed up to 42 days post head trauma. Systemic administration of the anti-calcitonin gene-related peptide mAb or its control IgG (30 mg/kg) began immediately after the 450 g injury or the third 150 g weight drop with additional doses given every 6 days subsequently. Results Rats subjected to 450 g closed head injury displayed an acute decrease in rearing and increased thigmotaxis, together with cephalic tactile pain hypersensitivity that resolved by 6 weeks post-injury. Injured animals also displayed delayed and prolonged extracephalic tactile pain hypersensitivity that remained present at 6 weeks post-injury. Repetitive subconcussive head impacts using the 150 g weight drop, but not a single event, led to decreased vertical rearing as well as cephalic and extracephalic tactile pain hypersensitivity that resolved by 6 weeks post-injury. Early and prolonged anti-calcitonin gene-related peptide mAb treatment inhibited the development of the cephalic tactile pain hypersensitivity in both the severe and repetitive subconcussive head impact models. Conclusions Severe head injury gives rise to a prolonged state of cephalic and extracephalic tactile pain hypersensitivity. These pain behaviors also develop following repetitive, subconcussive head impacts. Extended cephalic tactile pain hypersensitivity following severe and repetitive mild closed head injury are ameliorated by early and prolonged anti-calcitonin gene-related peptide mAb treatment, suggesting a mechanism linked to calcitonin gene-related peptide signaling, potentially of trigeminal origin.
- Published
- 2020
13. Symptoms of Autonomic Dysfunction Among Those With Persistent Posttraumatic Headache Attributed to Mild Traumatic Brain Injury: A Comparison to Migraine and Healthy Controls
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Gina Dumkrieger, Catherine D. Chong, Visar Berisha, Levi Howard, Katherine B. Ross, and Todd J. Schwedt
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Adult ,Male ,medicine.medical_specialty ,Traumatic brain injury ,Migraine Disorders ,Orthostatic intolerance ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Internal medicine ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Posttraumatic headache ,Brain Concussion ,Vasomotor ,business.industry ,medicine.disease ,Cross-Sectional Studies ,Autonomic Nervous System Diseases ,Neurology ,Migraine ,Weighted score ,Post-Traumatic Headache ,Female ,Neurology (clinical) ,Headaches ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Cohort study - Abstract
Background Most persistent posttraumatic headaches (PPTH) have a phenotype that meets diagnostic criteria for migraine or probable migraine. Although symptoms of autonomic dysfunction have been well described among those with migraine, the presence and relative severity of such symptoms among those with PPTH have yet to be reported. Objective The objective of this study was to assess and compare symptoms of autonomic dysfunction among those with PPTH attributed to mild traumatic brain injury (mTBI) vs migraine vs healthy controls using Composite Autonomic Symptom Score 31 (COMPASS-31) questionnaire scores. Methods Individuals with PPTH (n = 56) (87.5% of whom had a migraine/probable migraine phenotype), migraine (n = 30), and healthy controls (n = 36) were prospectively assessed in this cross-sectional cohort study using the COMPASS-31 questionnaire. Total COMPASS-31 scores and individual domain scores (bladder, gastrointestinal, orthostatic intolerance, pupillomotor, secretomotor, vasomotor) were compared between subject groups. Results COMPASS-31 mean total weighted score was 37.22 ± 15.44 in the PPTH group, 27.15 ± 14.37 in the migraine group, and 11.67 ± 8.98 for healthy controls. COMPASS-31 mean weighted total scores were significantly higher in those with PPTH vs migraine (P = .014), for PPTH vs healthy controls (P = .001), and for migraine vs healthy controls (P = .001). Those with PPTH had numerically higher scores for all COMPASS-31 domains compared to those with migraine, and the domain scores were significantly higher for orthostatic intolerance (PPTH = 4.80 ± 2.47 vs migraine = 3.33 ± 2.31, P = .027) and bladder (PPTH = 1.14 ± 1.45 vs migraine = 0.47 ± 0.73, P = .020). Among individuals with PPTH, post hoc correlations indicated a positive association between number of total lifetime TBIs with total weighted COMPASS-31 scores (rho = 0.32, P = .020), between years lived with headache and vasomotor domain subscores (rho = 0.27; P = .044), and between headache frequency with vasomotor domain subscores (rho = 0.27; P = .041). Conclusions Symptoms of autonomic dysfunction were greatest among those with PPTH compared to migraine and healthy controls. Among individuals with PPTH, number of lifetime TBIs was associated with greater symptoms of autonomic dysfunction, while greater headache burden was associated with higher vasomotor domain autonomic dysfunction subscores, potentially indicating that PPTH patients with higher disease burden have an increased risk for having autonomic dysfunction. Symptoms of autonomic dysfunction should be ascertained during the clinical management of patients with PPTH and might be a characteristic that helps differentiate PPTH from migraine.
- Published
- 2018
14. Posttraumatic Headache: Basic Mechanisms and Therapeutic Targets
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Andrew Charles and Joshua Kamins
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0301 basic medicine ,medicine.medical_specialty ,Traumatic brain injury ,business.industry ,medicine.disease ,Optimal management ,Head trauma ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Neurology ,Migraine ,Concussion ,medicine ,Animals ,Humans ,Post-Traumatic Headache ,Neurology (clinical) ,Intensive care medicine ,business ,Medical therapy ,Posttraumatic headache ,030217 neurology & neurosurgery ,Primary Headache Disorders - Abstract
Frequent or continuous headache, often refractory to medical therapy, is a common occurrence after head trauma. In addition to being the most common acute symptom after traumatic brain injury (TBI), headache is also one of the most persistent and disabling symptoms. Different studies indicate that 18-58% of those suffering a TBI will have significant headache at 1 year following the trauma. In addition to being disabling on its own, posttraumatic headache (PTH) is a predictor of overall outcome after concussion. Despite its remarkable prevalence and associated social and economic costs, many fundamental and important questions about PTH remain unanswered. The purpose of this review is to identify key questions regarding the clinical characteristics of posttraumatic headache, its basic mechanisms, and its optimal management. We discuss phenotypic features of PTH, pathophysiological mechanisms of TBI including potential overlaps with those of migraine and other primary headache disorders, and potential novel targets for treatment. We suggest different strategies to finding answers to the questions regarding PTH in order to advance the understanding of the disorder and develop more effective therapies.
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- 2018
15. Posttraumatic Headache: Classification by Symptom-Based Clinical Profiles
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Sylvia Lucas and Andrew H. Ahn
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030506 rehabilitation ,medicine.medical_specialty ,Traumatic brain injury ,business.industry ,Clinical course ,medicine.disease ,Clinical trial ,03 medical and health sciences ,0302 clinical medicine ,Daily headache ,Neurology ,Schema (psychology) ,medicine ,International Classification of Headache Disorders ,Neurology (clinical) ,Headaches ,medicine.symptom ,0305 other medical science ,Intensive care medicine ,business ,Posttraumatic headache ,030217 neurology & neurosurgery - Abstract
There are currently no accepted therapies for posttraumatic headache (PTH). In order to meet the urgent need for effective therapies for PTH, we must continue to address fundamental gaps in our understanding of the clinical course and impact of PTH. Here we examine the existing schema used to characterize the clinical characteristics of PTH, including the International Classification of Headache Disorders (ICHD). There remain unresolved questions about whether to classify patients based on the extent of brain injury or on clinical symptom profiles. There also remain problematic issues of definition such as continuous headache, and chronic daily headache with features of "embedded" migraine-type within these headaches, which will need to be studied further. We make the case that a symptom-based classification is needed to begin an examination of these unresolved questions, and to establish clinically relevant endpoints for research and clinical trials for effective therapies.
- Published
- 2018
16. Excessive daytime sleepiness in secondary chronic headache from the general population
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Michael Bjørn Russell, Espen Saxhaug Kristoffersen, Christofer Lundqvist, and Knut Stavem
- Subjects
Male ,Rhinosinusitis ,Excessive daytime sleepiness ,lcsh:Medicine ,Population-based ,0302 clinical medicine ,Surveys and Questionnaires ,Cervicogenic headache ,Odds Ratio ,Prevalence ,030212 general & internal medicine ,Rhinitis ,education.field_of_study ,Norway ,Epworth Sleepiness Scale ,Chronic pain ,General Medicine ,Cervicogenic ,Female ,medicine.symptom ,Headaches ,Adult ,Sleep Wake Disorders ,medicine.medical_specialty ,Headache Disorders ,Population ,Short Report ,03 medical and health sciences ,Internal medicine ,medicine ,Humans ,Sinusitis ,education ,Migraine ,Posttraumatic headache ,business.industry ,Tension-Type Headache ,lcsh:R ,Epworth sleepiness scale ,medicine.disease ,Cross-Sectional Studies ,Logistic Models ,Anesthesiology and Pain Medicine ,Physical therapy ,International Classification of Headache Disorders ,Self Report ,Neurology (clinical) ,business ,Sleep ,030217 neurology & neurosurgery - Abstract
Background Excessive daytime sleepiness (EDS, defined as Epworth sleepiness scale score > 10) is a common symptom, with a prevalence of 10–20% in the general population. It is associated with headache and other chronic pain disorders. However, little is known about the prevalence of EDS among people with secondary chronic headaches. Findings A total of 30,000 persons aged 30–44 from the general population was screened for headache by a questionnaire. The 633 eligible participants with self-reported chronic headache were interviewed and examined by a headache specialist who applied the International Classification of Headache Disorders with supplementary definitions for chronic rhinosinusitis and cervicogenic headache. A total of 93 participants had secondary chronic headache and completed the ESS. A total of 47 participants had chronic post-traumatic headache (CPTH) and/or cervicogenic headache (CEH), 39 participants had headache attributed to chronic rhinosinusitis (HACRS), while 7 had other secondary headaches. 23.3% of those with CPTH, CEH or HACRS reported EDS. In multivariable logistic regression analysis the odds ratios of EDS were not significantly different in people with CPTH/CEH or HACRS. Conclusion Almost one out of four subjects with secondary chronic headache reported EDS with no differences between the various secondary chronic headaches.
- Published
- 2017
17. The spectrum of mild traumatic brain injury
- Author
-
Andrew R. Mayer, Christina L. Master, and Davin K. Quinn
- Subjects
medicine.medical_specialty ,Views & Reviews ,business.industry ,Traumatic brain injury ,MEDLINE ,Chronic injury ,medicine.disease ,Diagnosis, Differential ,03 medical and health sciences ,Chronic traumatic encephalopathy ,0302 clinical medicine ,Animals ,Humans ,Medicine ,030212 general & internal medicine ,Neurology (clinical) ,Neurosurgery ,Differential diagnosis ,Medical diagnosis ,business ,Intensive care medicine ,Posttraumatic headache ,Brain Concussion ,030217 neurology & neurosurgery - Abstract
Objective:This review provides an in-depth overview of diagnostic schema and risk factors influencing recovery during the acute, subacute (operationally defined as up to 3 months postinjury), and chronic injury phases across the full spectrum of individuals (e.g., athletes to neurosurgery patients) with mild traumatic brain injury (mTBI). Particular emphasis is placed on the complex differential diagnoses for patients with prolonged postconcussive symptoms.Methods:Select literature review and synthesis.Results:In spite of an increase in public awareness surrounding the acute and potential long-term effects of mTBI, the medical field remains fragmented both in terms of the diagnostic (different criteria proffered by multiple medical organizations) and prognostic factors that influence patient care.Conclusions:Given the lack of objective biomarkers and the spectrum of different disorders that likely encompass mTBI, clinicians are encouraged to adopt a probabilistic, rather than definitive, diagnostic and prognostic framework. The relevance of accurately diagnosing and managing the different manifestations of mTBI becomes clear when one considers the overall incidence of the disorder (42 million people each year worldwide), and the different treatment implications for patients with a true neurodegenerative disorder (e.g., chronic traumatic encephalopathy; rare) vs potentially treatable conditions (e.g., depression or posttraumatic headache; frequent).
- Published
- 2017
18. 4286 The Relationship Between Tinnitus-Related Distress and PTSD Symptoms Among Post 9/11 Veterans with Posttraumatic Headache
- Author
-
Jim Mintz, John C. Moring, Cindy A. McGeary, Casey L Straud, Donald D. McGeary, Carlos A. Jaramillo, Willie J. Hale, Alan L. Peterson, Donald B. Penzien, Blessen C. Eapen, and Patricia A. Resick
- Subjects
Distress ,business.industry ,medicine ,General Medicine ,medicine.symptom ,business ,Posttraumatic headache ,Tinnitus ,Clinical psychology - Abstract
OBJECTIVES/GOALS: Military personnel are at significantly greater risk for developing tinnitus, due to increased exposure to acoustic trauma. Many psychiatric disorders are common among individuals with chronic tinnitus, including posttraumatic stress disorder (PTSD). Although tinnitus and PTSD are clearly different, research supports the notion of shared mechanisms between both disorders. First, there are overlapping symptoms between tinnitus-related distress and PTSD, including irritability, distorted cognitions, persistent negative emotional states, diminished interests in activities, exaggerated startle response, sleep disturbance, concentration problems, and hypervigilance. Second, tinnitus and PTSD are highly comorbid with one another, whereas 34% of veterans with tinnitus also carry a PTSD diagnosis. Third, those with both disorders are significantly more emotionally impaired compared to those with tinnitus and any other psychiatric disorder. Lastly, neuroimaging research has shown similar regions within the auditory vigilance network are implicated among those with tinnitus, and separately, among combat PTSD patients, suggesting shared neurobiological mechanisms between both disorders. Though we are aware that tinnitus and comorbid PTSD presents as a significantly greater clinical concern, the relationship between tinnitus-related distress and PTSD symptomotology it is still unknown. Canonical correlation analyses will be conducted to examine the relationship between tinnitus-related distress and PTSD among veterans as a part of a larger clinical trial for posttraumatic headache. Results of the study will shed light on the relationship between tinnitus-related distress and PTSD, and may suggest a different phenotype for those with both disorders. Researchers and clinicians will further understand and conceptualize the relationships among the cognitive, emotional, and behavioral symptoms associated with tinnitus and PTSD, both individually and conjointly. METHODS/STUDY POPULATION: Baseline data (N = 112) from a larger clinical trial examining the effectiveness of two different psychotherapies for the alleviation of posttraumatic headache was examined. The primary aim of this project was to evaluate the relationship between tinnitus-related distress and PTSD based on the eight subscale scores of the Tinnitus Functional Index (TFI) and the four scales of the Clinician Administered PTSD Scale for the DSM-5 (CAPS-5), respectively. To address this aim, canonical correlation analysis was used where the tinnitus-related symptom subscales made up one variable set and PTSD symptom subscales made up the second variable set. First, we evaluated the overall model fit based on Wilks Lambda to determine if the two variable sets were related at the p < .05 level. Next, we evaluated the canonical correlations (comparable to an eigenvalue) for each canonical dimension to determine the required number of significant canonical dimensions (or latent constructs) that were necessary to understand the association between the two variable sets. Finally, the standardized canonical coefficients, which are analogous to regression coefficients, evaluate the magnitude of variate relationships and determine which subscales best describe significant canonical dimensions. RESULTS/ANTICIPATED RESULTS: Prior to the canonical correlation analysis, total score descriptive statistics and subscale score zero-order correlations were carried out. The CAPS-5 total score was 33.24 (SD = 9.39) and the TFI total score was 50.81 (SD = 21.88) in this sample. Interpretation of the zero-order correlations indicated that TFI Relaxation subscale was the only tinnitus-related subscale moderately associated with a PTSD subscale (i.e., Reexperiencing, r = .35). Canonical correlation omnibus model fit analysis via the Wilks Lambda overall multivariate test indicated that the tinnitus variable set was significantly associated with the PTSD variable set, F = 1.55, p = .04. Evaluation of the canonical correlations indicated that one dimension was significant in explaining the relationship between the two variable sets and accounted for 25% of the overall variance, F = 1.55, p < .04, R2 = .249. Standardized canonical coefficients indicated that the PTSD subscales Reexperiencing (b = 0.64) and Negative Alterations in Cognition and Mood (b = 0.55) were the most representative of the identified canonical dimension. In terms of the TFI, the Relaxation (b = 1.28) and Sleep (b = 0.72) subscales appeared to be most related to the canonical dimension. The TFI subscales Auditory Difficulty (b = −0.30) and Quality of Life (b = 0.30) also appeared to be related the canonical dimension to a lesser degree. DISCUSSION/SIGNIFICANCE OF IMPACT: Findings support prior research suggesting particularly deleterious functional outcomes among individuals with comorbid tinnitus and PTSD. Results of this study suggest a latent variable that can explain the unique experience of individuals with both disorders. This latent variable consists of two PTSD constructs: Reexperiencing traumatic events (i.e., flashbacks, nightmares, intrusive memories), and Negative Alterations in Cognition and Mood (i.e., self- and other-blame, strong negative feelings, loss of interest, feeling distant). This latent variable also consists of two tinnitus-related constructs: Sleep (i.e., trouble falling and staying asleep, peaceful sleep) and Relaxation (i.e., ability to relax, enjoyment of peace and quiet). Auditory Difficulty (i.e., hear clearly, understand people) and Quality of Life (i.e., social activities, relationships, difficulty performing tasks) also contributed to the latent variable, but to a lesser degree. It is suggested that the constellation of symptoms related to the latent variable is a Dysphoric Factor, unique to individuals with PTSD, tinnitus, and posttraumatic headache. It may be necessary to incorporate different techniques into existing evidence-based treatments for both tinnitus and PTSD, for optimal symptom improvement.
- Published
- 2020
19. Posttraumatic headache and migraine assessment and management after sport-related concussion
- Author
-
Sheri A. Fedor, Jill R. Henley, Melissa N. Womble, and Michael W. Collins
- Subjects
medicine.medical_specialty ,Migraine ,business.industry ,medicine ,Physical therapy ,medicine.disease ,business ,Posttraumatic headache ,Sport related concussion - Published
- 2019
20. Challenging Case in Clinical Practice: Long-Term Relief from Chronic Posttraumatic Headache After Water-Only Fasting and an Exclusively Plant-Foods Diet
- Author
-
GershfeldNathan, R MyersToshia, C GoldhamerAlan, and M GoldmanDavid
- Subjects
medicine.medical_specialty ,business.industry ,Mechanism (biology) ,Traumatic brain injury ,food and beverages ,Plant foods ,medicine.disease ,030205 complementary & alternative medicine ,Clinical Practice ,03 medical and health sciences ,0302 clinical medicine ,Complementary and alternative medicine ,Physical therapy ,Medicine ,business ,Intensive care medicine ,Posttraumatic headache ,030217 neurology & neurosurgery - Abstract
Chronic posttraumatic headache (CPTHA) occurs in up to 95% of patients following traumatic brain injury (TBI) and can prove highly debilitating. The mechanism of CPTHA is poorly understood...
- Published
- 2017
21. The relationship of migraine and other headache disorders to concussion
- Author
-
Tad Seifert
- Subjects
Pediatrics ,medicine.medical_specialty ,business.industry ,030229 sport sciences ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Ion homeostasis ,Migraine ,Cortical spreading depression ,Concussion ,medicine ,Headache Disorders ,business ,Posttraumatic headache ,030217 neurology & neurosurgery - Abstract
Concussion and migraine share many similar pathophysiologic mechanisms, including cortical spreading depression and failure in brain ion homeostasis. Migraine may predispose to concussion, and migraine and posttraumatic headache are common following concussion. This overlap may interfere with proper diagnosis following sport injury, thereby delaying either appropriate treatment or return-to-play. Posttraumatic headache is the most common symptom following concussion, and although symptoms are indistinguishable from migraine, persistent posttraumatic headache may be a unique entity that is more refractory to traditional headache management. There are few studies investigating the diagnosis and treatment of posttraumatic headache. This chapter provides a broad overview of migraine and other headache disorders in sport, with a specific focus on emerging treatment paradigms for posttraumatic headache.
- Published
- 2018
22. Posttraumatic Headache in Concussed Young Adult Athletes
- Author
-
Deanna Jung
- Subjects
medicine.medical_specialty ,biology ,Athletes ,business.industry ,Primary care ,biology.organism_classification ,Tertiary care ,Health care delivery ,Physical therapy ,medicine ,Young adult ,business ,Cardiovascular nursing ,Posttraumatic headache ,Health care financing - Published
- 2017
23. When Treatment Establishes Diagnosis: A Case Report of Posttraumatic Chronic Paroxysmal Hemicrania
- Author
-
David Watson, Sneha Jacob, and Jack E. Riggs
- Subjects
medicine.medical_specialty ,business.industry ,medicine.disease ,Dermatology ,03 medical and health sciences ,0302 clinical medicine ,Neurology ,Chronic paroxysmal hemicrania ,Trigeminal autonomic cephalgia ,Medicine ,030212 general & internal medicine ,Neurology (clinical) ,business ,Posttraumatic headache ,030217 neurology & neurosurgery - Published
- 2018
24. Treatment of posttraumatic headache migraine phenotype with erenumab – An observational study
- Author
-
James A. Charles
- Subjects
Pediatrics ,medicine.medical_specialty ,business.industry ,medicine.disease ,Phenotype ,Clinical algorithm ,lcsh:RC321-571 ,Pharmacotherapy ,Migraine ,Concussion ,Medicine ,Observational study ,lcsh:Sports medicine ,lcsh:RC1200-1245 ,business ,lcsh:Neurosciences. Biological psychiatry. Neuropsychiatry ,Posttraumatic headache - Abstract
Objective To report the observed effect of erenumab in mild posttraumatic headache migraine phenotype with and without aura. Background There is no clinical algorithm of pharmacotherapy for migraine following posttraumatic headache. Most migraine preventatives that are typically used are either ineffective or not tolerated. Methods Seven patients who met the clinical criteria for migraine with or without aura following posttraumatic headache who failed or were intolerant of conventional migraine preventatives were treated with erenumab 140 mg subcutaneously. Most had no history of migraine. In those patients with a history of migraine, the posttraumatic headache migraine headaches were different than the past migraine experience. Descriptive headache intensity or disability using the Head Impact Test-6 and monthly headache days were recorded before and after treatment. All patients were debilitated on presentation and demonstrated no signs of spontaneous resolution. Results Patients responded with a 95% (SD 1.22, p Conclusions Erenumab is effective in the treatment of posttraumatic headache with migraine phenotype in this small cohort. Large-scale studies are urgently required for this highly prevalent, disabling, condition which has no effective established treatment.
- Published
- 2019
25. Photophobia symptoms and visual pain thresholds in posttraumatic headache after mild traumatic brain injury
- Author
-
Todd J. Schwedt, Nicholas Jarvis, and Amaal J. Starling
- Subjects
Photophobia ,Traumatic brain injury ,business.industry ,Beck Depression Inventory ,medicine.disease ,symbols.namesake ,Anesthesia ,Threshold of pain ,medicine ,symbols ,Neurology (clinical) ,Two sample ,medicine.symptom ,business ,Posttraumatic headache ,State-Trait Anxiety Inventory ,Fisher's exact test - Abstract
BackgroundLight sensitivity can be a disabling symptom in posttraumatic headache (PTH). The objective of this pilot study was to characterize photophobia symptoms and visual pain thresholds in PTH compared to healthy controls (HC).MethodsIndividuals with PTH attributed to mild traumatic brain injury (mTBI) (N = 18) and HC (N = 20), aged 18–65, were prospectively assessed using the Photosensitivity Assessment Questionnaire (PAQ), State Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI). A progressive light stimulation device was used to quantify visual pain thresholds. Visual pain thresholds were determined by the intensity of light at which subjects first noted pain. The mean of 3 trials was considered the visual pain threshold. Two sample t-test, Wilcoxon rank sum test, χ2 test and Fisher exact test was used to compare the 2 groups for their demographics, clinical characteristics, and outcomes measures.ResultsThere were no differences in demographics including age, gender, or race. The average time since onset of PTH was 50.7 (73.6) months. Those with PTH had 15.8 (9.2) headache days per month. BDI and STAI scores were significantly higher in PTH compared to HC. Photophobia was higher in PTH compared to HC, 0.64 (0.25) vs 0.24 (0.24), p < 0.0001. Visual pain thresholds were lower in PTH (median 50.1 lux; quartiles 15.3 to 300.0) compared to HC (median 863.5 lux; quartiles 519.9 to 4,906.5; p = 0.0002).ConclusionPhotophobia symptoms are higher and visual pain thresholds are lower in PTH compared to HC. Light sensitivity is a well-known disabling symptom in PTH and this pilot study provides objective data through a validated photophobia scale and visual pain thresholds to characterize light sensitivity. Additional studies are needed to confirm this data, to compare acute to persistent PTH, to compare PTH to other headache disorders, and to determine if photophobia and visual pain thresholds will improve with intervention.
- Published
- 2018
26. Pediatric Posttraumatic Headache
- Author
-
Ryan Hung, Heidi K. Blume, and Joanne Kacperski
- Subjects
medicine.medical_specialty ,business.industry ,Traumatic brain injury ,Disease Management ,medicine.disease ,Pediatrics ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Pediatrics, Perinatology and Child Health ,Epidemiology ,Concussion ,medicine ,Physical therapy ,Humans ,Post-Traumatic Headache ,Neurology (clinical) ,Headaches ,medicine.symptom ,Disease management (health) ,Intensive care medicine ,business ,Posttraumatic headache ,030217 neurology & neurosurgery - Abstract
Concussion and mild traumatic brain injury are common injuries in pediatrics, and posttraumatic headache is the most common complaint following them. Although most children and teens recover from a simple, isolated concussion without incidents within 1-2 weeks, some develop symptoms that can last for months. It is important to manage both acute and persistent posttraumatic headaches appropriately to speed recovery, minimize disability, and maximize function. In this article, we review the definitions, epidemiology, and current recommendations for the evaluation and treatment of acute and persistent posttraumatic headaches. Although this is still a developing field and there is much that we still need to learn about concussion and the best strategies to prevent and treat these injuries and their sequelae, we hope that this review will help providers to understand the current evidence and treatment recommendations to improve care for children with concussion and mild traumatic brain injury.
- Published
- 2016
27. A Child with Chronic Posttraumatic Headache
- Author
-
Ishaq Abu-Arafeh
- Subjects
Pediatrics ,medicine.medical_specialty ,Primary headache ,business.industry ,Concussion ,Head injury ,medicine ,medicine.disease ,business ,Posttraumatic headache - Abstract
Chronic posttraumatic headache (CPTH) is defined as a headache presenting for the first time or exacerbated by a trauma to the head or the neck. CPTH takes onset within a week of the trauma and persists for over 3 months. It usually follows a chronic course, but often benign and self-limiting. Diagnosis is based on clinical assessment. Investigations are not usually necessary unless there are other clinical indications. Treatment is mainly with reassurance and on similar lines to other primary headaches.
- Published
- 2016
28. Pediatric Posttraumatic Headache
- Author
-
Christopher Melinosky, Stephen Ross, Matthew Silvis, and Harry Bramley
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Traumatic brain injury ,Refractory ,Head Injuries, Closed ,medicine ,Humans ,Child ,Glucocorticoids ,Posttraumatic headache ,Acute pain ,Trauma Severity Indices ,business.industry ,General Medicine ,medicine.disease ,Clinical trial ,Pediatrics, Perinatology and Child Health ,Emergency Medicine ,Post-Traumatic Headache ,Treatment strategy ,Female ,Headaches ,medicine.symptom ,business ,Follow-Up Studies - Abstract
Pediatric traumatic brain injury is a common occurrence, and even an ostensibly mild injury may result in disabling posttraumatic headaches. The headache may result in a number of subsequent unremitting symptoms refractory to many standard headache therapies. Current treatment recommendations are sparse because there is a lack of clinical trial data recommendations and outcomes. From these 2 cases, we report the effectiveness of steroids for severe posttraumatic headache, along with recommended treatment strategies for acute pain management and prevention.
- Published
- 2012
29. Obstacles to Claiming Permanence and Injury-Relatedness for 'Posttraumatic' Headache
- Author
-
Robert J. Barth
- Subjects
medicine.medical_specialty ,business.industry ,Medicine ,business ,Psychiatry ,Posttraumatic headache ,Post-Traumatic Headache - Abstract
“Posttraumatic” headaches claims are controversial because they are subjective reports often provided in the complex of litigation, and the underlying pathogenesis is not defined. This article reviews principles and scientific considerations in the AMAGuides to the Evaluation of Permanent Impairment (AMA Guides) that should be noted by evaluators who examine such cases. Some examples in the AMA Guides, Sixth Edition, may seem to imply that mild head trauma can cause permanent impairment due to headache. The author examines scientific findings that present obstacles to claiming that concussion or mild traumatic brain injury is a cause of permanent headache. The World Health Organization, for example, found a favorable prognosis for posttraumatic headache, and complete recovery over a short period of time was the norm. Other studies have highlighted the lack of a dose-response correlation between trauma and prolonged headache complaints, both in terms of the frequency and the severity of trauma. On the one hand, scientific studies have failed to support the hypothesis of a causative relationship between trauma and permanent or prolonged headaches; on the other hand, non–trauma-related factors are strongly associated with complaints of prolonged headache.
- Published
- 2009
30. Posttraumatic Headache: Clinical Characterization and Management
- Author
-
Sylvia Lucas
- Subjects
medicine.medical_specialty ,Pediatrics ,Traumatic brain injury ,Neuropsychological Tests ,Severity of Illness Index ,Risk Factors ,Severity of illness ,Concussion ,medicine ,Prevalence ,Humans ,Cumulative incidence ,Risk factor ,Posttraumatic headache ,business.industry ,General Medicine ,medicine.disease ,United States ,Anesthesiology and Pain Medicine ,Migraine ,Brain Injuries ,Physical therapy ,Post-Traumatic Headache ,Neurology (clinical) ,business - Abstract
Headache is the most common symptom after traumatic brain injury (TBI). TBI has become a global health concern with an estimated 2.5 million reported TBIs per year in the USA alone. Recent longitudinal studies of posttraumatic headache (PTH) show a high cumulative incidence of 71 % after moderate or severe TBI and an even higher cumulative incidence of 91 % after mild TBI (mTBI) at 1 year after injury. Prevalence remains high at over 44 % throughout the year after moderate or severe TBI and over 54 % after mTBI. A prior history of headache is associated with a higher risk for PTH, whereas older age appears to be protective. Gender does not appear to be a risk factor for PTH. Most PTH has clinical diagnostic criteria meeting that of migraine or probable migraine when primary headache disorder classification criteria are used, followed by tension-type headache. There are no evidence-based treatment guidelines for PTH management; however, expert opinion has suggested treating the PTH using primary headache disorder treatment recommendations according to its type.
- Published
- 2015
31. Posttraumatic headache
- Author
-
Marc E, Lenaerts and James R, Couch
- Subjects
Pediatrics ,medicine.medical_specialty ,Ihs criteria ,business.industry ,Analgesic ,Neuromodulation (medicine) ,Head trauma ,Medicine ,Anxiety ,Neurology (clinical) ,medicine.symptom ,business ,Posttraumatic headache ,Depression (differential diagnoses) - Abstract
Posttraumatic headache (PTH) is divided into acute and chronic groups whose management and prognosis are clearly different. Although IHS criteria stipulate that PTH should have an onset within 2 weeks of the trauma, it has been observed that a headache linked to the trauma can start later. PTH can be clinically divided into the following groups: migraine-like headache, tension-type-like headache, cluster-like headache, cervicogenic-like headache, and others. Based on these clinical distinctions, therapy can be administered accordingly. However, the distinction is relative and numerous clinical features may be common to all. There seems to be a weak inverse relationship between the severity of the head trauma and the occurrence of a PTH, especially chronic. A holistic approach is not only useful but it is necessary for a therapeutic success. Early and aggressive treatment and empathy are essential to the patient's improvement. Prompt recognition and treatment of laceration, peripheral nociceptive sources such as cervical joint displacement, vascular factors, may diminish chronicity. Neuromodulation of pain with prophylactic agents is recommended early. Although it is less necessary for the acute PTH, it will be crucial for the chronic form and should be initiated no later than 2 months cut-off time between acute and chronic PTH. Recognition and treatment of psychiatric factors such as depression and anxiety will lessen the risk of chronicity. Analgesic rebound-withdrawal headache commonly is seen in chronic PTH. This must be corrected rapidly because it can protract the headache and render other inappropriate therapeutic measures inefficient.
- Published
- 2004
32. Disability and Chronic Posttraumatic Headache
- Author
-
Dawn A. Marcus
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pediatrics ,Neurological disorder ,Physical function ,Central nervous system disease ,Quality of life ,medicine ,Craniocerebral Trauma ,Humans ,Disabled Persons ,In patient ,Posttraumatic headache ,business.industry ,Headache ,Psychological distress ,medicine.disease ,Neurology ,Chronic Disease ,Quality of Life ,Physical therapy ,Female ,Neurology (clinical) ,business ,Complication ,Stress, Psychological - Abstract
Objective.—To test the hypothesis that chronic posttraumatic headache is associated with greater severity and psychological distress than headache of nontraumatic origin. Methods.—Two hundred eighty-nine consecutive patients with chronic headache attending a university headache clinic were evaluated. Questionnaires about headache symptoms, quality of life (Medical Outcome Survey SF-36 Health Survey), and psychological distress were completed. Results.—Frequent headache (>4 days per week) occurred more often with traumatic (84%) than nontraumatic headache (60%). Traumatic headache resulted in greater reduced activity (3.31 ± 1.06 days per week versus 2.62 ± 1.11 days per week with nontraumatic headache; P
- Published
- 2003
33. Intraoral Topical Nonsteroidal Antiinflammatory Drug Application for Headache Prevention
- Author
-
Mark H. Friedman, Caren F. Behar, William H. Frishman, and Stephen J. Peterson
- Subjects
Adult ,Male ,Ketoprofen ,Adolescent ,Headache Disorders ,Administration, Topical ,Analgesic ,Gingiva ,Pilot Projects ,chemistry.chemical_compound ,medicine ,Humans ,Posttraumatic headache ,Antiinflammatory drug ,Nonsteroidal ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,Maxillary nerve ,Middle Aged ,medicine.disease ,Clinical trial ,Treatment Outcome ,Migraine ,chemistry ,Anesthesia ,Female ,Cardiology and Cardiovascular Medicine ,business ,Gels ,medicine.drug - Abstract
Recent evidence suggests an association between migraine and tension-type headache and local inflammation occurring in a maxillary nerve segment. This study was designed to evaluate the efficacy of topical ketoprofen for the prevention of migraine, tension-type, and posttraumatic headache. Patients with a headache frequency of at least once a week recorded the frequency, severity, duration, and type of headache for 60 days. After 30 days, patients applied the medication daily for the next 30 days to the periapical area of the maxillary molars on the symptomatic side(s). Headache medications and analgesics were permitted, as needed. Headache burden was defined as the average intensity of each headache (0-10 scale) multiplied by its duration, in hours. The average monthly headache burden score for the 20 patients enrolled in this study decreased from 454.8 (30-day baseline) to 86.5 P < 0.001 during the 30-day treatment phase. Analgesic and headache medication intake were significantly reduced from baseline during the treatment phase, and side effects were minimal.
- Published
- 2002
34. Headaches, Traumatic Brain Injury, and Concussion
- Author
-
Jay L. Alberts and Neil Cherian
- Subjects
Neurologic function ,Disturbance (geology) ,Traumatic brain injury ,business.industry ,Anesthesia ,Concussion ,medicine ,Headaches ,medicine.symptom ,medicine.disease ,business ,Posttraumatic headache ,Brain function - Abstract
Concussion is considered a subset of traumatic brain injury (TBI) resulting in a transient disturbance in brain function, due to a direct or indirect blow to the head. Head-trauma-related symptoms are quite common and varied. Eighty to ninety percent of individuals recover neurologic function within 10 days of injury.
- Published
- 2014
35. Clinical Assessment of Posttraumatic Headaches
- Author
-
Ross Zafonte and Lawrence J. Horn
- Subjects
medicine.medical_specialty ,Rehabilitation ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Headache ,Physical Therapy, Sports Therapy and Rehabilitation ,Physical examination ,medicine.disease ,Craniocerebral trauma ,Vascular Headaches ,Laboratory examination ,medicine ,Etiology ,Physical therapy ,Craniocerebral Trauma ,Humans ,Neurology (clinical) ,Vascular headache ,Headaches ,medicine.symptom ,business ,Physical Examination ,Posttraumatic headache - Abstract
The evaluation of the person with posttraumatic headache remains a difficult clinical task. The rehabilitation clinician seeing the person with posttraumatic headache may encounter a large spectrum of potential etiologies for cephalgia. We believe an ordered approach to the history, physical, and laboratory examination may lead to a more accurate and focused diagnosis in some cases. In an attempt to provide a directed approach to posttraumatic headaches, this discussion is divided into extracranial and intracranial sources. A brief table guide to the etiology of pain by site is presented, and the key eight steps of examination are reviewed.
- Published
- 1999
36. Subcutaneous Sumatriptan in an Adolescent With Acute Posttraumatic Headache
- Author
-
Carsten G. Bönnemann, Nicholas S. Abend, and Michael L. Nance
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Sumatriptan ,business.industry ,Injections, Subcutaneous ,Serotonin Receptor Agonists ,Treatment management ,Anesthesia ,Acute Disease ,Pediatrics, Perinatology and Child Health ,medicine ,Humans ,Post-Traumatic Headache ,Neurology (clinical) ,Medication overuse ,business ,Posttraumatic headache ,Acute posttraumatic headache ,medicine.drug - Abstract
Acute posttraumatic headache is common and can evolve into chronic posttraumatic headache, which is associated with medication overuse and disability. However, there are few studies to guide treatment management of acute posttraumatic headache. We describe an adolescent with acute posttraumatic headache that did not respond to several initial medications but had rapid and sustained improvement in headache and associated migrainous features with subcutaneous sumatriptan.
- Published
- 2008
37. Recognizing Exercise-Related Headache
- Author
-
Paul McCrory
- Subjects
medicine.medical_specialty ,education.field_of_study ,biology ,Athletes ,business.industry ,fungi ,Population ,food and beverages ,Physical Therapy, Sports Therapy and Rehabilitation ,Physical exercise ,Neurological disorder ,biology.organism_classification ,medicine.disease ,Cervicogenic headache ,Physical therapy ,Medicine ,Aerobic exercise ,Orthopedics and Sports Medicine ,business ,Head and neck ,education ,Posttraumatic headache - Abstract
Active patients may suffer not only from the common headache syndromes that plague the general population, but also from headache brought on by exercise. Valsalva-type maneuvers can bring on exertional headache; maximal or submaximal aerobic activity can precipitate effort headache. Trauma to the head and neck can lead to posttraumatic headache. Other headache syndromes in athletes include cervicogenic headache, goggle headache, diver's headache, and altitude headache.
- Published
- 1997
38. Migraine associated with head trauma: revision of International Headache Society's criteria for posttraumatic headache? A reply to D.C. Haas; AUTHORS RESPONSE
- Author
-
M. B. Russell and Jes Olesen
- Subjects
medicine.medical_specialty ,Neurology ,Migraine ,business.industry ,medicine ,Neurology (clinical) ,Psychiatry ,medicine.disease ,business ,Posttraumatic headache ,Head trauma - Published
- 2013
39. Painful Outcomes of Parafunctional Clenching
- Author
-
Francis Hartmann and Gérard Cucchi
- Subjects
medicine.medical_specialty ,Physical medicine and rehabilitation ,Stomatognathic system ,business.industry ,Fibromyalgia ,Medicine ,Medial pterygoid muscle ,Clinical settings ,business ,medicine.disease ,Posttraumatic headache ,Craniofacial pain - Abstract
When stressful situations are poorly managed, intensive and/or durable diurnal or nocturnal muscular contraction indicates a particularly deleterious parafunction for the stomatognathic system. Many observations have shed light on the aggravating role of parafunctional habits particularly with regard to craniofacial pain. The various trigeminal projections to non-trigeminal centers may prove useful to practitioners faced with uncommon clinical settings, particularly when stressed patients complain about painful symptoms very remote from the oral sphere. It can specially happen with some patients classified as fibromyalgia when classical treatments remain uneffective. Then to search the obvious parafunctional clenching can bring a major therapeutic key to the clinician.
- Published
- 2013
40. Repeat CT or MRI in Posttraumatic Headache
- Author
-
Timothy B. Donovan, Stephen H. Landy, and Robert E. Laster
- Subjects
Adult ,Male ,medicine.medical_specialty ,Neurological disorder ,Temporal lobe ,Central nervous system disease ,Hematoma ,medicine ,Craniocerebral Trauma ,Humans ,Posttraumatic headache ,Cerebral Hemorrhage ,Vascular disease ,business.industry ,Headache ,medicine.disease ,Subdural Hematomas ,Magnetic Resonance Imaging ,Surgery ,Hematoma, Subdural ,Neurology ,Female ,Neurology (clinical) ,Radiology ,Tomography, X-Ray Computed ,Complication ,business - Abstract
Repeat CT or MRI of the brain should be considered in posttraumatic headache. We describe two patients with posttraumatic headache who had negative CT scans on initial presentation. One patient later had bilateral subdural hematomas on CT, and the other had temporal lobe hemorrhage on MRI. We recommend considering repeat CT or MRI for persisting posttraumatic headache and mental status change.
- Published
- 1996
41. (339) Cerebral grey matter changes associated with posttraumatic headache in mild traumatic brain injury patients: a longitudinal MRI study
- Author
-
David A. Seminowicz, Rao P. Gullapalli, C. Sours, Shana A.B. Burrowes, Timothy J. Meeker, and Joel D. Greenspan
- Subjects
Traumatic brain injury ,business.industry ,Grey matter ,medicine.disease ,030227 psychiatry ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Neurology ,Anesthesia ,medicine ,Neurology (clinical) ,business ,Posttraumatic headache - Published
- 2016
42. Characteristics of acute posttraumatic headache following mild head injury
- Author
-
Petra Klaschterka, Astrid Knopf, Doris Lieba-Samal, Christian Wöber, Stefan Seidel, and Patrick Platzer
- Subjects
Adult ,Male ,medicine.medical_specialty ,business.industry ,Head injury ,030229 sport sciences ,General Medicine ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Migraine ,medicine ,Physical therapy ,Prevalence ,Craniocerebral Trauma ,Humans ,Post-Traumatic Headache ,Observational study ,Female ,Neurology (clinical) ,business ,Posttraumatic headache ,030217 neurology & neurosurgery ,Acute posttraumatic headache - Abstract
Background: To examine the prevalence and characteristics of acute posttraumatic headache (APTH) attributed to mild head injury within a prospective, observational study design. Methods: We recruited 100 patients with acute mild head injury as defined in the International Classification of Headache Disorders, 2nd Edition (ICHD-2) presenting to the department of trauma surgery at the Medical University of Vienna. Patients underwent a detailed telephone interview between days 7 and 10 and between days 90 and 100 after the injury. Results: The prevalence of APTH was 66%. APTH had occurred within 24 hours after the trauma in 78% and lasted for a median of 3.0 days. Headache was unilateral in 45%. Aggravation by physical activity, nausea and photo-/phonophobia was present in 49%, 42% and 55%, respectively. The prevalence of APTH was related to conditions of chronic pain (excluding headache), pre-existing episodic headache, number of posttraumatic symptoms, anxiety and depression. At follow-up at 90–100 days, posttraumatic headache had abated in all patients. Conclusions: APTH attributed to mild head injury is a common but self-limiting condition frequently showing migrainous features. Participants with chronic pain other than headache, pre-existing headache and affective disorders are at higher risk of developing APTH. None of the patients developed chronic posttraumatic headache.
- Published
- 2011
43. Postinjury Issues and Ethics of Return to Play in Pediatric Concussion
- Author
-
Jennifer Niskala Apps, Jason S. Doescher, and Kevin D. Walter
- Subjects
medicine.medical_specialty ,Concussion management ,business.industry ,medicine.disease ,Return to play ,Chronic traumatic encephalopathy ,Neurocognitive Dysfunction ,Concussion ,Chronic headaches ,Medicine ,business ,Psychiatry ,Psychosocial ,Posttraumatic headache - Abstract
Concussion management is an individualized process and therefore can be confusing to patients, parents, and other caregivers. There are guidelines to assist in identifying concussion symptoms and suggest return-to-play plans, but each patient deserves a unique approach to their injury. This chapter reviews the potential long-term complications of concussion, including chronic traumatic encephalopathy, chronic headaches, and neurocognitive dysfunction. It also explores the possible management options for concussed children and adolescents, many of which are emerging and somewhat experimental. Long-term psychosocial concerns are addressed. The ethics of return-to-play are also discussed.
- Published
- 2011
44. Poster 15: Physician Perception of Posttraumatic Headache and Practice Patterns
- Author
-
Kathleen R. Bell, Sylvia Lucas, Allen W. Brown, Jeanne M. Hoffman, and Sureyya Dikmen
- Subjects
medicine.medical_specialty ,Neurology ,Practice patterns ,business.industry ,Rehabilitation ,Physical therapy ,medicine ,Physician perception ,Physical Therapy, Sports Therapy and Rehabilitation ,Neurology (clinical) ,business ,Posttraumatic headache - Published
- 2010
45. Headache attributed to head or neck trauma
- Author
-
Miguel J. A. Láinez, Giorgio Bono, and Anna Piera
- Subjects
medicine.medical_specialty ,Pediatrics ,business.industry ,Postconcussion syndrome ,medicine.disease ,Primary headache ,Migraine ,Neck injury ,medicine ,Whiplash ,Physical therapy ,Headaches ,medicine.symptom ,business ,Posttraumatic headache ,Neck trauma - Abstract
Publisher Summary This chapter presents an overview of all types of posttraumatic headache (PTH): acute PTH, chronic PTH, and headache after a whiplash injury, taking account of the definition and latest criteria of International Headache Classification II (ICHD-II). Headache is a symptom that may occur after injury to the head, neck, or brain. PTH is a cardinal symptom of the “postconcussion syndrome” and may be accompanied by somatic, psychological, or cognitive disturbances. PTH is always a new-onset headache resulting from brain, head, and sometimes neck injury, and can simulate the clinical characteristics of several primary headaches. Severe, moderate, and mild head injuries can cause PTH. It is easy to establish the relationship between a headache and the trauma when it starts immediately or in the initial days after head or neck trauma. The pathogenesis of chronic symptoms is not known: neurological, psychological, and legal factors are involved. PTH and headache attributed to whiplash may be treated early or associated complications will appear (daily occurrence of headache, overuse of analgesic medication, and comorbid psychiatric disorders). Preventive and symptomatic treatments may be prescribed in relation to clinical patterns of headache (tension-type, migraine, cluster, or cervicogenic headaches), as a primary headache. Physiotherapy, psychotherapy, and resolution of litigation can be contributing factors for recovery.
- Published
- 2010
46. Posttraumatic Headache: Permanency and Relationship to Legal Settlement
- Author
-
F.A.C.P. Russell C. Packard M.D.
- Subjects
Adult ,Male ,Work ,medicine.medical_specialty ,Nonprescription Drugs ,Interviews as Topic ,medicine ,Craniocerebral Trauma ,Humans ,Psychiatry ,Posttraumatic headache ,Retrospective Studies ,Jurisprudence ,business.industry ,Headache ,Persistent headache ,Retrospective cohort study ,Chronic disease ,Neurology ,Telephone interview ,Blunt trauma ,Chronic Disease ,Female ,Neurology (clinical) ,Headaches ,medicine.symptom ,Settlement (litigation) ,business - Abstract
In our increasingly litigious society there is persistence of an attitude that posttraumatic headache (or other injuries) will either improve or disappear following resolution of a claim. In some states (Florida) in order for a person to initiate a claim, an injury must be considered permanent. This is often a difficult task with a subjective symptom. This retrospective study was performed to evaluate the reliability of criteria used to diagnose a "permanent" posttraumatic headache and whether these headaches stay "permanent" after legal settlement. Data was obtained by a structured telephone interview of fifty adult outpatients diagnosed as having permanent posttraumatic headache and their litigation settled at least one year previously. Patients with previous headaches, other accidents or head injuries were excluded. The average length of time from settlement to interview was 23 months. Forty-six had been in automobile accidents and four either had falls or blunt trauma to the head. (Eight cases involved Workman's Compensation). Criteria used at this clinic for determining permanency were either posttraumatic headache persisting for longer than one year with no evidence of further improvement (43 patients) or patients with headaches persisting longer than 6 months with a plateau (no change) in their pattern for three months or more with an adequate trial of treatment (in our judgement). These criteria did seem reliable. All fifty patients interviewed continued to report persistent headache symptoms one year or more following legal settlement. Improvement in headache pattern after legal settlement was only reported by four patients.
- Published
- 1992
47. Treating Athletes Who Have Posttraumatic Headaches
- Author
-
Seymour Diamond
- Subjects
medicine.medical_specialty ,Sports injury ,biology ,business.industry ,Athletes ,Physical Therapy, Sports Therapy and Rehabilitation ,biology.organism_classification ,medicine.disease ,Head trauma ,Migraine ,Neurologic abnormalities ,Physical therapy ,Medicine ,Orthopedics and Sports Medicine ,Headaches ,medicine.symptom ,business ,Posttraumatic headache - Abstract
In brief Many sports injuries involve head trauma and subsequent posttraumatic headache. Three types of posttraumatic headache occur: migraine, cluster, and tension-type. Each type may be acute or chronic. Diagnosis requires ruling out organic causes and neurologic abnormalities. Treatment includes abortive and prophylactic therapies.
- Published
- 1992
48. Posttraumatic Headache and the Postconcussion Syndrome
- Author
-
Jerome Goldstein
- Subjects
business.industry ,Postconcussion syndrome ,Head injury ,Headache ,General Medicine ,Irritability ,medicine.disease ,Anesthesia ,Craniocerebral Trauma ,Humans ,Medicine ,medicine.symptom ,business ,ALCOHOL INGESTION ,Posttraumatic headache ,Brain Concussion - Abstract
Although headache is the most common sequelae of head injury, the posttraumatic headache is associated frequently with dizziness, irritability, lack of concentration, and intolerance to alcohol ingestion as a part of a symptom complex known as the postconcussion syndrome. This article clarifies the definitions of acute traumatic headache, posttraumatic headache, and the postconcussion syndrome and improves diagnostic ability, making the assessment and treatment of patients with these three conditions more accurate and effective.
- Published
- 1991
49. Posttraumatic headache-IHS chapter 5
- Author
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Holger Schmidt, Peter S. Sandor, and Rita Schaumann-von Stosch
- Subjects
medicine.medical_specialty ,business.industry ,International Classification of Diseases ,Terminology as Topic ,MEDLINE ,Medicine ,Humans ,Post-Traumatic Headache ,Neurology (clinical) ,General Medicine ,business ,Psychiatry ,Posttraumatic headache - Published
- 2008
50. Headache Post-Traumatic Brain Injury
- Author
-
J. G. Millichap
- Subjects
Pediatrics ,medicine.medical_specialty ,Traumatic brain injury ,business.industry ,traumatic brain injury ,lcsh:RJ1-570 ,lcsh:Pediatrics ,medicine.disease ,serious headache ,medicine ,Physical therapy ,posttraumatic headache ,business ,Prospective cohort study ,Posttraumatic headache - Abstract
Researchers at University of Washington, Seattle, and Children's Hospital of Philadelphia, PA conducted a prospective cohort study of the prevalence of headache 3 and 12 months after traumatic brain injury (TBI) in children ages 5 to 17 years.
- Published
- 2012
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