Current Research on the Diagnosis and Management of Persistent Post-Traumatic Headache

Headache is a common symptom in patients with concussion and mild traumatic brain injury. While many patients experience spontaneous resolution of symptoms following injury, a subset develop persistent post-traumatic headache, and evidence-based guidance for the management of this condition remains limited in current clinical practice.

Persistent post-traumatic headache (PPTH) is likely underrecognized, with evidence suggesting that individuals with a prior history of headache disorders or previous concussion may be at increased risk. Scheduled analgesics in the first 72 hours following injury or utilizing infusions can help reduce symptom severity in the acute period following injury. Pharmacological studies are limited but suggest treating based on the headache phenotype. Anti-CGRP therapies have shown promise in a variety of chronic headache types including PPTH, and non-pharmacological interventions including introduction of early exercise programs, cognitive behavioral therapy, and biofeedback can improve long term patient outcomes. Although the available evidence is limited, current research supports phenotype-guided pharmacologic treatment alongside a multidisciplinary approach incorporating early exercise and cognitive behavioral therapy.