Dwyer Brigid
Department of Neurology, Boston University School of Medicine, Boston, Massachusetts.
Brain Injury Program, HealthSouth Braintree Rehabilitation Hospital, Braintree, Massachusetts.
Semin Neurol. 2018 Dec;38(6):619-626. doi: 10.1055/s-0038-1673692. Epub 2018 Dec 6.
Posttraumatic headaches are among the most challenging complaints after mild traumatic brain injury (mTBI). They are a debilitating problem experienced by patients after TBI of all severities. Up to 90% of mild TBI patients experience headache, particularly if female and with a premorbid history of primary headache. Tension headache has classically been the most common subtype, but in military populations migraine has dominated. Posttraumatic headache encompasses a spectrum of headache types that overlap heavily with common primary headache disorders, but also autonomic cephalgias as well as several secondary headache conditions. It is important to understand the evolution of postconcussion syndrome as a concept, and the challenges associated with diagnosing and treating multidomain drivers effectively. The first-line treatments for posttraumatic headache are typically the same as those used in nontraumatic headache, with additional considerations for cognitive side effects, posttraumatic epilepsy, and coexisting injuries resulting in neuropathic pain or medication overuse.
创伤后头痛是轻度创伤性脑损伤（mTBI）后最具挑战性的主诉之一。它们是所有严重程度的创伤性脑损伤患者都会经历的使人衰弱的问题。高达90%的轻度创伤性脑损伤患者会出现头痛，尤其是女性且有原发性头痛的病前病史者。紧张性头痛一直是最常见的亚型，但在军人中偏头痛占主导地位。创伤后头痛包括一系列头痛类型，这些类型与常见的原发性头痛疾病有很大重叠，也包括自主神经性头痛以及几种继发性头痛情况。理解脑震荡后综合征这一概念的演变，以及有效诊断和治疗多领域驱动因素所面临的挑战很重要。创伤后头痛的一线治疗通常与非创伤性头痛的治疗相同，同时要额外考虑认知副作用、创伤后癫痫以及导致神经性疼痛或药物滥用的并存损伤。
