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Mavroudis, I.; Ciobica, A.; Luca, A.C.; Balmus, I. Treatment of Post-Traumatic Headache. Encyclopedia. Available online: https://encyclopedia.pub/entry/46433 (accessed on 22 June 2024).
Mavroudis I, Ciobica A, Luca AC, Balmus I. Treatment of Post-Traumatic Headache. Encyclopedia. Available at: https://encyclopedia.pub/entry/46433. Accessed June 22, 2024.
Mavroudis, Ioannis, Alin Ciobica, Alina Costina Luca, Ioana-Miruna Balmus. "Treatment of Post-Traumatic Headache" Encyclopedia, https://encyclopedia.pub/entry/46433 (accessed June 22, 2024).
Mavroudis, I., Ciobica, A., Luca, A.C., & Balmus, I. (2023, July 05). Treatment of Post-Traumatic Headache. In Encyclopedia. https://encyclopedia.pub/entry/46433
Mavroudis, Ioannis, et al. "Treatment of Post-Traumatic Headache." Encyclopedia. Web. 05 July, 2023.
Treatment of Post-Traumatic Headache
Edit

Post-traumatic headache (PTH) is a common and debilitating consequence of mild traumatic brain injury (mTBI) that can occur over one year after the head impact event. Thus, better understanding of the underlying pathophysiology and risk factors could facilitate early identification and management of PTH. There are several factors that could influence the reporting of PTH prevalence, including the definition of concussion and PTH. The main risk factors for PTHs include a history of migraines or headaches, female gender, younger age, greater severity of the head injury, and co-occurring psychological symptoms, such as anxiety and depression. 

post-traumatic headache mild traumatic brain injury post-concussion syndrome

1. Introduction

Post-traumatic headache (PTH) is a common and debilitating consequence of mild traumatic brain injury (mTBI). Despite its high prevalence and significant impact on daily functioning and quality of life, PTH remains a complex and poorly understood phenomenon. Several controversies also address the prevalence rates of PTH [1][2][3]. Moreover, a significant proportion of individuals suffering from PTH continue to experience symptoms one year after the injury, indicating chronic PTH [4]. This highlights the need for a better understanding of the underlying pathophysiology and risk factors to facilitate early identification and management of PTH.
The pathophysiological mechanisms underlying PTH remains not fully understood; however, both migraine and TBI mechanisms seem implicated in the impaired descending pain modulation, neurometabolic changes, neuroinflammation, cortical spreading depression, and release of the calcitonin-gene-related peptide (CGRP) seen in both pathologies [5]. The development and persistence of PTH may be more related to neuroinflammation and trigeminal system activation implicated in migraine and other primary headache disorders than to the mechanisms underlying TBI [5]. TBI can lead to immediate effects of brain concussion, cerebral blood vessel damage, and axonal shearing, as well as a secondary cascade of metabolic and cellular excitotoxic and inflammatory changes that can promote the development of PTH [6]. Despite this, the relationship between TBI mechanisms and PTH was not clearly established. The similarities between PTH and migraine are supported by the observation that patients with PTH who have no prior history of migraine exhibit hypersensitivity to CGRP [7]. CGRP is a neuropeptide that may mediate trigemino-vascular pain transmission and trigger a migraine attack [8][9]. CGRP antagonists are a class of medications used in the acute and preventive treatment of migraine. A study of patients with PTH found that 28% had a 50% reduction in days with moderate or severe headache following open-label treatment with erenumab, a CGRP receptor antagonist [10] (Table 1).
Table 1. Summary of pathophysiological mechanisms involved in PTH pathogenesis.

References

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  6. Ladak, A.A.; Enam, S.A.; Ibrahim, M.T. A Review of the Molecular Mechanisms of Traumatic Brain Injury. World Neurosurg. 2019, 131, 126.
  7. Shina, H.; Iljazi, A.; Al-Khazali, H.M.; Christensen, C.E.; Amin, F.M.; Ashina, M.; Schytz, H.W. Hypersensitivity to Calcitonin Gene-Related Peptide in Post-Traumatic Headache. Ann. Neurol. 2020, 88, 1220.
  8. Triplett, G.; Hill, C.; Freeman, L.; Rajan, U.; Templer, D.I. Incidence of head injury: Lasting effects among college students and working adults in the general population. Percept. Mot. Ski. 1996, 83 Pt 2, 1344–1346.
  9. Charles, A.; Pozo-Rosich, P. Targeting calcitonin gene-related peptide: A new era in migraine therapy. Lancet 2019, 394, 1765.
  10. Ashina, H.; Iljazi, A.; Al-Khazali, H.M.; Eigenbrodt, A.K.; Larsen, E.L.; Andersen, A.M.; Hansen, K.J.; Bräuner, K.B.; Mørch-Jessen, T.; Chaudhry, B.; et al. Efficacy, tolerability, and safety of erenumab for the preventive treatment of persistent post-traumatic headache attributed to mild traumatic brain injury: An open-label study. J. Headache Pain 2020, 21, 62.
  11. Vanderploeg, R.D.; Belanger, H.G.; Horner, R.D.; Spehar, A.M.; Powell-Cope, G.; Luther, S.L.; Scott, S.G. Health outcomes associated with military deployment: Mild traumatic brain injury.; blast.; trauma.; and combat associations in the Florida National Guard. Arch. Phys. Med. Rehabil. 2012, 93, 1887–1895.
  12. Cushman, D.M.; Borowski, L.; Hansen, C.; Hendrick, J.; Bushman, T.; Teramoto, M. Gabapentin and Tricyclics in the Treatment of Post-Concussive Headache.; a Retrospective Cohort Study. Headache 2019, 59, 371–382.
  13. Erickson, J.C. Treatment outcomes of chronic post-traumatic headaches after mild head trauma in US soldiers: An observational study. Headache 2011, 51, 932–944.
  14. Mollica, A.; Safavifar, F.; Fralick, M.; Giacobbe, P.; Lipsman, N.; Burke, M.J. Transcranial Magnetic Stimulation for the Treatment of Concussion: A Systematic Review. Neuromodulation 2021, 24, 803–812.
  15. Rosner, M.S.; Feinberg, D.L.; Doble, J.E.; Rosner, A.J. Treatment of vertical heterophoria ameliorates persistent post-concussive symptoms: A retrospective analysis utilizing a multi-faceted assessment battery. Brain Inj. 2016, 30, 311–317.
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  18. Yerry, J.A.; Kuehn, D.; Finkel, A.G. Onabotulinum toxin a for the treatment of headache in service members with a history of mild traumatic brain injury: A cohort study. Headache 2015, 55, 395–406.
  19. Klein, S.K.; Brown, C.B.; Ostrowski-Delahanty, S.; Bruckman, D.; Victorio, M.C. Identifying Migraine Phenotype Post Traumatic Headache (MPTH) to Guide Overall Recovery From Traumatic Brain Injury. J. Child Neurol. 2022.
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