Posttraumatic headache: recent progress.

Area of Science:

• Neurology
• Trauma Research
• Headache Medicine

Background:

• Posttraumatic headache (PTH) is a common and disabling consequence of mild traumatic brain injury (mTBI).
• Up to 50% of acute PTH cases evolve into persistent PTH, lasting over 3 months.
• The high prevalence and chronicity of PTH underscore the need for research into its underlying mechanisms and effective treatments.

Purpose of the Study:

• To review recent advancements in the diagnostic criteria for PTH.
• To discuss the complex pathophysiology of PTH.
• To explore current and emerging treatment strategies for PTH.

Main Methods:

• Review of current literature on PTH diagnostic criteria based on the International Classification of Headache Disorders 3.
• Analysis of preclinical and human research investigating PTH pathophysiology.
• Evaluation of existing evidence for acute and preventive PTH therapies, including conventional and novel approaches.

Main Results:

• PTH diagnostic criteria require headache onset within 7 days of head trauma, with persistence defined as lasting over 3 months.
• Emerging evidence suggests multiple pathophysiologic mechanisms, including genetic factors, neuroinflammation, neurotransmitter imbalances, and brain remodeling, indicating PTH is distinct from primary headaches.
• High-quality evidence for PTH treatment is limited, but studies on therapies like CGRP mAbs and TMS show promise for future randomized controlled trials.

Conclusions:

• PTH exhibits a complex pathophysiology, distinct from primary headaches.
• While robust clinical trials are needed, current research provides valuable data for designing future PTH treatment studies.
• Ongoing investigations aim to elucidate PTH mechanisms, identify predictors of persistence, and establish evidence-based therapeutic options.