John Graham Senior Clinicians Award Lecture. Posttraumatic migraine

The term posttraumatic migraine has been used in several contexts. The purpose of this discussion is to outline the different circumstances in which migraine may follow trauma. Cases from the literature and from the Headache Unit of Montefiore Medical Center are reviewed. Although trauma may be one of many triggers of migraine, trauma is sometimes the sole or predominant precipitating factor; e.g., footballer's migraine. In the posttraumatic syndrome, some exacerbations of headache upon a background of chronic daily headache often fulfill the criteria of migraine. Trauma may trigger the first attack of migraine in a susceptible individual. Biochemical and epidemiologic studies suggest that trauma may be the main etiologic factor of migraine in some cases. Migraine may also follow trauma on the basis of chance. Differentiating the different types of posttraumatic migraine has diagnostic, therapeutic, and legal implications.