Symptomatic approach to posttraumatic headache and its possible implications for treatment

We investigated 112 patients [mean age 39.5 +/- 10.5 years, 59% women (n=66)] with chronic posttraumatic headache following cranio-cervical acceleration/deceleration trauma after an average time interval of 2.5 +/- 1.9 years from trauma. Headache following minor head injury or whiplash is one of the most prominent problems in neurotraumatology. Previous research is inconclusive regarding the symptomatic approach of this type of headache. Details of the phenomenology of posttraumatic headache in the previous literature are inconclusive. This may lead to inappropriate treatment strategies, because recent advances in therapy of different headache types may be neglected. Patients were investigated at the outpatient service of the Department of Psychiatry. Headache was analyzed according to its principal location, laterality, projection, quality, precipitation or aggravation and possible additional symptoms. For this analysis, headache was diagnosed according to the classification of the International Headache Society. The results showed that 42 patients (37%) had tension-type headache, 30 (27%) were identified as suffering from migraine, whereas 20 patients (18%) had cervicogenic headache. An additional 18% of patients suffered from headache that did not fulfill criteria of a particular category. In 104 patients (93%), neck pain was associated in time with headache. Each of the diagnosed headache types in this study may require specific treatment strategies based upon empirical studies of non-traumatic headache types. For these reasons a detailed analysis of headache following cranio-cervical acceleration/deceleration trauma is necessary.