Post-traumatic headaches

Abstract

Post-traumatic headache is the most frequent secondary headache disorder. PTH is more likely to develop after mild traumatic brain injury and can persist due to neuroinflammation and chronic sensitization of nociceptors. Acute PTH should be treated aggressively with analgetics, also moderate subthreshold activity 24 to 48 hours after the trauma is recommended to avoid chronification processes. PTH usually presents as tension-type-like headache, but also migraine-like or even trigeminal autonomic cephalalgias can rarely occur. Medical treatment options should be selected according to the presenting headache phenotype. Triggerpoint injections, occipital nerve blocks and treatment targeting CGRP with botulinumtoxin or CGRP-antibodies may also be effective. A multidisciplinary biopsychosocial treatment approach involving behavioral and physical therapy as well as treatment of comorbid post-traumatic symptoms is most likely to be effective.