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Post-traumatic headache: facts and doubts
Rita Formisano1, Umberto Bivona, Sheila Catani
1Post-Coma Unit and Headache Center, IRCCS Fondazione Santa Lucia, Rome, Italy. r.formisano@hsantalucia.it
The Journal of Headache and Pain
|March 19, 2009
Summary
Post-traumatic headache (PTH) diagnosis in traumatic brain injury (TBI) patients needs better criteria than the current 3-month window. Severe TBI cases show fewer PTH cases but may have organic lesions, unlike mild TBI with psychological issues.
Area of Science:
- Neurology
- Neuroscience
- Pain Medicine
Background:
- Current classifications inadequately address headache severity in traumatic brain injury (TBI).
- Glasgow Coma Scale (GCS) < 13 defines moderate to severe TBI, lacking nuance for headache assessment.
- The 3-month parameter for post-traumatic headache (PTH) occurrence/resolution may be insufficient due to variable coma and amnesia durations.
Purpose of the Study:
- To evaluate the characteristics and diagnostic challenges of post-traumatic headache (PTH) in severe traumatic brain injury (TBI).
- To explore the relationship between TBI severity, coma duration, and the development of PTH.
- To investigate the correlation between PTH, cognitive function, and psychopathological changes post-TBI.
Main Methods:
- Analysis of TBI patients with a focus on headache presentation and severity.
- Assessment of coma duration, post-traumatic amnesia, and Glasgow Coma Scale (GCS) scores.
- Evaluation of cognitive functioning, psychopathological status (anxiety, depression), and organic findings (skull fractures, EEG abnormalities) at 1-year follow-up.
Main Results:
- Fewer TBI patients with longer coma duration and more severe TBI presented with PTH at 1-year follow-up.
- Severe TBI patients with PTH often exhibited skull fractures, dural lacerations, and EEG abnormalities.
- Psychopathological changes like anxiety and depression were noted, particularly in severe TBI patients with good cognitive recovery.
Conclusions:
- The 3-month timeframe for PTH assessment is likely inadequate for severe TBI.
- PTH in severe TBI is associated with organic lesions, contrasting with psychological disturbances in mild TBI.
- Affective pain perception in TBI patients may depend on cognitive function integrity.
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