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Post-Traumatic Headache

Mitul Kapadia, Alison Scheid, Eric Fine, Rachel Zoffness
PURPOSE OF REVIEW: Post-concussion syndrome (PCS), when the patient's concussion symptoms last longer than 4-6 weeks, affects 10-30% of concussion patients. PCS presents a significant source of morbidity to patients and a management challenge to providers. In this review, we present the current evidence and best management approaches for pediatric PCS. RECENT FINDINGS: There is limited high-quality evidence in pediatric PCS. There is some evidence supporting pharmaceutical management of post-traumatic headaches, cognitive symptoms, and emotional symptoms...
February 13, 2019: Current Reviews in Musculoskeletal Medicine
Suzanne Barker-Collo, Alice Theadom, Nicola J Starkey, Michael Kahan, Kelly Jones, Valery Feigin
BACKGROUND: Previous studies of the Rivermead Post-Concussive Questionnaire(RPQ)'s factor structure were conducted within 1 year post-injury. Post-concussive symptoms may persist, and are common in the general population, so determining if the factor structure in mild-TBI and controls differ is important. This study examined factor structure of the RPQ in adults 4 years post-mild-TBI and in age-/gender-matched controls. METHOD: A total of 232 adults 4 years post-mild-TBI and 232 age-/gender-matched controls completed the RPQ...
January 30, 2019: Brain Injury: [BI]
Karen A Williams, Robin M Lawson, Osvaldo H Perurena, John D Coppin
Introduction: The rate of chronic migraine (CM) has been shown to be 20% or greater in the post 9/11 combat veteran population with a history of traumatic brain injury, while the rate is much lower at 3-5% in the general population. Studies have shown that medications such as oral topiramate or intramuscular injections of onabotulinum toxin A (Botox) have been used for CM prevention, and occipital blocks have been shown to be helpful in treating occipital neuralgia and short-term relief of CM...
January 23, 2019: Military Medicine
Domizia Vecchio, Paola Naldi, Veronica Ferro, Cristoforo Comi, Maurizio Angelo Leone, Roberto Cantello
BACKGROUND: Lumbar puncture (LP) is a safe procedure commonly performed in the diagnostic work-up of multiple sclerosis (MS), and its main adverse event is post-LP headache (PLPH). Predictors for PLPH in MS are not established. AIMS: To describe the occurrence of, and, factors related to PLPH in patients with suspected MS, studied on a daily-basis admission. PATIENTS AND METHODS: One hundred patients (70 females) were admitted for a diagnostic LP (standardized with a traumatic 19-G needle), observed for 6 h, and evaluated for adverse events 2 and 7 days later...
January 21, 2019: Neurological Sciences
Dara Bree, Dan Levy
Post-traumatic headache (PTH) is one of the most common, debilitating and difficult symptoms to manage after a traumatic head injury. While the mechanisms underlying PTH remain elusive, recent studies in rodent models suggest the potential involvement of calcitonin gene-related peptide (CGRP), a mediator of neurogenic inflammation, and the ensuing activation of meningeal mast cells (MCs), pro-algesic resident immune cells that can lead to the activation of the headache pain pathway. Here, we investigated the relative contribution of MCs to the development of PTH-like pain behaviors in a model of mild closed head injury (mCHI) in male rats...
January 7, 2019: Pain
Xuan Niu, Lijun Bai, Yingxiang Sun, Shan Wang, Jieli Cao, Chuanzhu Sun, Zhuonan Wang, Hui Xu, Shuoqiu Gan, Geng Fan, Wenmin Huang, Chenghui Gu, Bo Yin, Guanghui Bai, Xiaoling Xu, Ming Zhang
OBJECTIVE: Post-traumatic headache (PTH) is one of the most frequent and persistent physical symptoms following mild traumatic brain injury (mTBI) and develop in more than 50% of this population. This study aimed to investigate the periaqueductal grey (PAG)-seeded functional connectivity (FC) in patients with mTBI with acute post-traumatic headache (APTH) and further examine whether the FC can be used as a neural biomarker to identify patients developing chronic pain 3 months postinjury...
December 15, 2018: Journal of Neurology, Neurosurgery, and Psychiatry
Laura S Moye, Alycia F Tipton, Isaac Dripps, Zoie Sheets, Aimee Crombie, Jonathan D Violin, Amynah A Pradhan
Headaches are highly disabling and are among the most common neurological disorders worldwide. Despite the high prevalence of headache, therapeutic options are limited. We recently identified the delta opioid receptor (DOR) as an emerging therapeutic target for migraine. In this study, we examined the effectiveness of a hallmark DOR agonist, SNC80, in disease models reflecting diverse headache disorders including: chronic migraine, post-traumatic headache (PTH), medication overuse headache by triptans (MOH), and opioid-induced hyperalgesia (OIH)...
December 13, 2018: Neuropharmacology
Christopher Mares, Jehane H Dagher, Mona Harissi-Dagher
The most common symptom of post-concussive syndrome (PCS) is post-traumatic headache (PTH) accompanied by photophobia. Post-traumatic headache is currently categorized as a secondary headache disorder with a clinical phenotype described by its main features and resembling one of the primary headache disorders: tension, migraine, migraine-like cluster. Although PTH is often treated with medication used for primary headache disorders, the underlying mechanism for PTH has yet to be elucidated. The goal of this narrative literature review is to determine the current level of knowledge of these PTHs and photophobia in mild traumatic brain injury (mTBI) in order to guide further research and attempt to discover the underlying mechanism to both symptoms...
December 4, 2018: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
Mia Minen, Sarah Jinich, Gladys Vallespir Ellett
BACKGROUND: There are no clear guidelines on how to treat posttraumatic headache (PTH) or post-concussive symptoms (PCS). However, behavioral interventions such as cognitive behavioral therapy, biofeedback, and relaxation are Level-A evidence-based treatments for headache prevention. To understand how to develop and study further mind-body interventions (MBIs) and behavioral therapies for PTH and PCS, we developed the following question using the PICO framework: Are behavioral therapies and MBIs effective for treating PTH and PCS? METHODS: We conducted a systematic search of 3 databases (Medline, PsycINFO, and EMBASE) for behavioral interventions and MBIs with the subject headings and keywords for PTH, concussion, and traumatic brain injury (TBI)...
December 1, 2018: Headache
Noah D Silverberg, Paul Martin, William Panenka
Most patients with primary headache disorders identify environmental stimuli (e.g., visual glare), situational factors (e.g., stress), physiological states (e.g., hormones), or activities (e.g., exercise) as triggers that elicit or worsen headache episodes. Headache triggers have not been previously studied in post-traumatic headache (PTH). The present study explored the frequency of headache triggers and their avoidance in PTH. Participants with mild traumatic brain injury (TBI) were recruited from outpatient specialty clinics and completed questionnaires at or soon after their initial clinic visit...
November 29, 2018: Journal of Neurotrauma
Virginia B Baker, Kathryn M Eliasen, Nawaz K Hack
OBJECTIVE: Our aim was 1) to reduce disability, as characterized by headache frequency, duration and severity in patients with post-traumatic headache (PTHA), 2) to reduce the number of medical boards and work limitations in patients with post traumatic headache, and 3) to reduce use of medical resources and clinic visits related to headache or migraine. BACKGROUND: Modifiable risk factors for PTHA include stressful life event, sleep disturbances, and medication overuse...
November 22, 2018: Journal of Headache and Pain
Russell Lane, Paul Davies
AIM: To explore post traumatic headache characteristics and risk factors in compensation claimants by observational retrospective cohort analysis. CASE RESULTS: Medicolegal reports on 116 consecutive compensation claimants aged 41.9 ± 15.0 years were reviewed 21 ± 14 months after injury. Eighty eight had suffered head and neck injuries, 21 reported only neck injury and seven had "other injuries". Ninety four percent of the head injuries were "mild"...
November 8, 2018: Cephalalgia: An International Journal of Headache
Sheridan M Hoy
Fremanezumab-vfrm (hereafter referred to as fremanezumab) [AJOVY™] is a fully humanized monoclonal antibody (IgG2Δa) developed by Teva Pharmaceuticals to selectively target calcitonin gene-related peptide (a vasodilatory neuropeptide involved in the pathophysiology of migraine). Its use has been associated with significant reductions in migraine frequency, the requirement for acute headache medication use and headache-related disability compared with placebo in multinational, phase III studies, and in September 2018 fremanezumab was approved by the US FDA for the preventive treatment of migraine in adults...
November 2018: Drugs
Scott L Zuckerman, Benjamin L Brett, Aaron S Jeckell, Aaron M Yengo-Kahn, Gary S Solomon
PURPOSE OF REVIEW: Sport-related concussion (SRC) and mild traumatic brain injury (mTBI) have been thrust into the national spotlight, with youth athletes bearing the burden of this public health problem. The current review aims to provide a practical summary of pediatric SRC, including key terminology, return to play/school, and risk factors for post-concussion syndrome (PCS). RECENT FINDINGS: While the majority of youth athletes recover within 2 to 4 weeks, approximately 10% of athletes experience a protracted recovery with symptoms lasting months, impacting social, scholastic, and sporting activities...
November 5, 2018: Current Neurology and Neuroscience Reports
Paige E Studlack, Kaspar Keledjian, Tayyiaba Farooq, Titilola Akintola, Volodymyr Gerzanich, J Marc Simard, Asaf Keller
Blast-induced traumatic brain injury (blast-TBI) is associated with vestibulomotor dysfunction, persistent post-traumatic headaches and post-traumatic stress disorder, requiring extensive treatments and reducing quality-of-life. Treatment and prevention of these devastating outcomes require an understanding of their underlying pathophysiology through studies that take advantage of animal models. Here, we report that cranium-directed blast-TBI in rats results in signs of pain that last at least 8 weeks after injury...
October 22, 2018: Brain Injury: [BI]
John Whalen, Sheldon Yao, Adena Leder
PURPOSE OF REVIEW: This review highlights the importance of osteopathic manipulative treatment (OMT) in headache sufferers. OMT is a viable option for patients who either do not wish to use pharmaceuticals or who have contraindications to pharmaceuticals. Patients with headaches that are refractory to other treatment options may also be candidates for OMT. Multiple headache etiologies are amenable to this non-invasive treatment option and they will be reviewed here. Although there are advantages to using this treatment method, there are also shortcomings in the literature, which will be discussed...
October 5, 2018: Current Pain and Headache Reports
Cayden Peixoto, Lindsay Hyland, Derrick Matthew Buchanan, Erika Langille, Richard Nahas
Background: The polytrauma clinical triad (PCT) is a complex disorder composed of three comorbid diagnoses of chronic pain, post-traumatic stress disorder (PTSD), and postconcussion syndrome (PCS). PCT has been documented in veterans returning from deployment, but this is the first report on PCT prevalence in nonmilitary personnel after a motor vehicle collision (MVC). Methods: Data were drawn from routine intake assessments completed by 71 patients referred to a community-based clinic for chronic pain management...
2018: Journal of Pain Research
Pamela Blake, Rony-Reuven Nir, Carlton J Perry, Rami Burstein
Background The therapeutic benefit of nerve decompression surgeries for chronic headache/migraine are controversial. Aim To provide clinical characteristics of headache type and treatment outcome of occipital nerve decompression surgery. Methods A retrospective review of clinical records. Inclusion criteria were evidence of chronic occipital headache with and without migrainous features and tenderness of neck muscles, occipital allodynia, and inadequate response to prophylactic drugs. Results Surgical decompression of the greater and lesser occipital nerves provided complete and extended (3-6 years) relief of new daily persistent headache in case 3 (46 year old female), and of chronic post-traumatic headache in cases 4 and 6 (35 and 30 year old females, respectively), partial relief of chronic headache/migraine in cases 1 and 2 (41 year old female and 36 year old male), and no relief of episodic (cases 3 and 4) or chronic migraine (case 5, 52 year old male), or chronic tension-type headache (case 7, 31 year old male)...
September 14, 2018: Cephalalgia: An International Journal of Headache
Ryan Ross
The increase in road traffic accidents in twentieth-century Britain brought with it a rise in the number of patients admitted to hospital with blunt, non-penetrating head injuries. Patients who had suffered mild to moderate trauma typically complained of a variety of problems, including headaches, dizziness and giddiness. For the neurologists tasked with diagnosing and treating these patients, such symptoms proved difficult to assess and liable to obscure the clinical picture. This article focuses on why neurologists turned to time as a diagnostic-tool in helping to resolve these issues, specifically the measurement of post-traumatic amnesia (PTA)...
October 2018: Medical History
Luis Henrique Albuquerque Sousa, Luana Antunes Maranha Gatto, Zeferino Demartini Junior, Gelson Luis Koppe
Scalp cirsoid aneurysm is an arteriovenous fistula of the scalp that is unconnected by intracranial or cerebral vessels. Variceal dilatation of draining veins can produce cosmetic concerns, masses, local pain, palpable thrills, and audible bruits, headache, tinnitus, and hemorrhage. Its etiopathogenesis is not well understood. Treatment includes surgery (fistula repair by simple surgical ligation until gross total resection), embolization (whether percutaneous or endovascular), or a combination of the two. An updated systematic review of the last 10 years publications was performed...
November 2018: World Neurosurgery
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