Systematic review of interventions for post-traumatic headache

Headache is one of the most common physical symptoms after traumatic brain injury (TBI). The specific goals of this review include (1) determination of effective interventions for post-traumatic headache (PTHA), (2) development of treatment recommendations, (3) identification of gaps in the current medical literature regarding PTHA treatment, and (4) suggestions for future directions in research to improve outcome for persons with PTHA.

Peer-reviewed studies in PubMed, CINAHL, PsycINFO, ProQuest, Web of Science, and Google Scholar: (1) including adult and child samples with mild, moderate, or severe TBI, whiplash, and postconcussion syndrome; (2) with clearly described interventions; (3) with headache treatment as a primary or secondary outcome; (4) published since 1985; and (5) written in English.

Abstracts from 812 articles from the above searches were reviewed. All research types that studied the treatment of headache after TBI were included, and 64 of the 812 articles appeared to meet the inclusion criteria.

The 64 articles were reviewed in full and data were extracted; 36 met all criteria for inclusion. The final 36 articles were rated according to the American Academy of Neurology criteria for classifying therapeutic studies.

No class I studies and only one class II study for the management of PTHA were identified. One class I and one class II study for whiplash-associated disorder with headache as an outcome were identified. Twelve studies met criteria for class III.

No strong evidence from clinical trials is available to direct the treatment of PTHA. Some guidelines are offered for PTHA management based on primary headache categories and treatments. It is essential that well-designed clinical studies be conducted to inform clinicians on the management and prevention of PTHA chronicity.