Neurology Service, Madigan Army Medical Center, Tacoma, WA, USA.
Headache. 2011 Jun;51(6):932-44. doi: 10.1111/j.1526-4610.2011.01909.x. Epub 2011 May 17.
he effectiveness of medical therapies for chronic post-traumatic headaches (PTHs) attributable to mild head trauma in military troops has not been established.
To determine the treatment outcomes of acute and prophylactic medical therapies prescribed for chronic PTHs after mild head trauma in US Army soldiers.
A retrospective cohort study was conducted with 100 soldiers undergoing treatment for chronic PTH at a single US Army neurology clinic. Headache frequency and Migraine Disability Assessment (MIDAS) scores were determined at the initial clinic visit and then again by phone 3 months after starting headache prophylactic medication. Response rates of headache abortive medications were also determined. Treatment outcomes were compared between subjects with blast-related PTH and non-blast PTH.
Ninety-nine of 100 subjects were male. Seventy-seven of 100 subjects had blast PTH and 23/100 subjects had non-blast PTH. Headache characteristics were similar for blast PTH and non-blast PTH with 96% and 95%, respectively, resembling migraine. Headache frequency among all PTH subjects decreased from 17.1 days/month at baseline to 14.5 days/month at follow-up (P = .009). Headache frequency decreased by 41% among non-blast PTH compared to 9% among blast PTH. Fifty-seven percent of non-blast PTH subjects had a 50% or greater decline in headache frequency compared to 29% of blast PTH subjects (P =.023). A significant decline in headache frequency occurred in subjects treated with topiramate (n = 29, -23%, P = .02) but not among those treated with a low-dose tricyclic antidepressant (n = 48, -12%, P = .23). Seventy percent of PTH subjects who used a triptan class medication experienced reliable headache relief within 2 hours compared to 42% of subjects using other headache abortive medications (P = .01). Triptan medications were effective for both blast PTH and non-blast PTH (66% response rate vs 86% response rate, respectively; P = .20). Headache-related disability, as measured by mean MIDAS scores, declined by 57% among all PTH subjects with no significant difference between blast PTH (-56%) and non-blast PTH (-61%).
Triptan class medications are usually effective for aborting headaches in military troops with chronic PTH attributed to a concussion from a blast injury or non-blast injury. Topiramate appears to be an effective headache prophylactic therapy in military troops with chronic PTH, whereas low doses of tricyclic antidepressants appear to have little efficacy. Chronic PTH triggered by a blast injury may be less responsive to commonly prescribed headache prophylactic medications compared to non-blast PTH. These conclusions require validation by prospective, controlled clinical trials.
慢性创伤后头痛（PTH）的医学治疗效果在军事部队中归因于轻度头部创伤的有效性尚未得到证实。
确定美国陆军士兵因轻度头部创伤导致慢性 PTH 后使用急性和预防性医学治疗的治疗结果。
对一家美国陆军神经科诊所接受慢性 PTH 治疗的 100 名士兵进行了回顾性队列研究。在初始诊所就诊时以及开始头痛预防性药物治疗后 3 个月通过电话确定头痛频率和偏头痛残疾评估（MIDAS）评分。还确定了头痛缓解药物的缓解率。将与爆炸相关的 PTH 和非爆炸 PTH 患者的治疗结果进行了比较。
100 名受试者中有 99 名为男性。100 名受试者中有 77 名患有爆炸相关 PTH，23 名患有非爆炸 PTH。爆炸相关 PTH 和非爆炸相关 PTH 的头痛特征相似，分别为 96%和 95%，类似于偏头痛。所有 PTH 受试者的头痛频率从基线时的 17.1 天/月降至随访时的 14.5 天/月（P =.009）。与爆炸相关 PTH 相比，非爆炸相关 PTH 的头痛频率下降了 41%。与爆炸相关 PTH 相比，57%的非爆炸相关 PTH 受试者头痛频率下降了 50%或更多（P =.023）。接受托吡酯治疗的受试者头痛频率显著下降（n = 29，-23%，P =.02），而接受低剂量三环类抗抑郁药治疗的受试者（n = 48，-12%，P =.23）。在 2 小时内经历可靠头痛缓解的 PTH 受试者中，使用曲坦类药物的受试者占 70%，而使用其他头痛缓解药物的受试者占 42%（P =.01）。曲坦类药物对爆炸相关 PTH 和非爆炸相关 PTH 均有效（分别为 66%的缓解率和 86%的缓解率，P =.20）。所有 PTH 受试者的头痛相关残疾（以平均 MIDAS 评分衡量）下降了 57%，且爆炸相关 PTH（-56%）和非爆炸相关 PTH（-61%）之间无显著差异。
在患有因爆炸伤或非爆炸伤引起的轻度头部创伤导致的慢性 PTH 的军人中，曲坦类药物通常可有效缓解头痛。托吡酯似乎是治疗慢性 PTH 的有效头痛预防疗法，而低剂量三环类抗抑郁药似乎效果不大。与常见的预防性头痛药物相比，爆炸引起的慢性 PTH 可能对预防性药物的反应较差。这些结论需要前瞻性、对照临床试验的验证。
