Schwedt Todd J
Department of Neurology, Mayo Clinic, Scottsdale, AZ, United States.
Front Neurol. 2019 Jun 14;10:615. doi: 10.3389/fneur.2019.00615. eCollection 2019.
By definition, post-traumatic headache (PTH) attributed to mild traumatic brain injury (mTBI) is not associated with brain structural abnormalities that are seen on routine clinical inspection of brain images. However, subtle brain structural abnormalities, as well as functional abnormalities, detected via research imaging techniques yield insights into the pathophysiology of PTH. The objective of this manuscript is to summarize published findings regarding research imaging of the brain in PTH attributed to mTBI. For this narrative review, PubMed was searched using the terms "post-traumatic headache" or "post-concussion headache" and "imaging" or "magnetic resonance imaging" or "research imaging" or "positron emission tomography". Articles were chosen for inclusion based on their relevance to the topic. Ten articles were ultimately included within this review. The studies investigated white matter tract integrity and functional connectivity in acute PTH, structural measures, white matter tract integrity, cerebral blood flow, and functional connectivity in persistent PTH (PPTH), and proton spectroscopy in both acute and persistent PTH. The articles demonstrate that acute and persistent PTH are associated with abnormalities in brain structure, that acute and persistent PTH are also associated with abnormalities in brain function, that it might be possible to predict the persistence of PTH using brain imaging findings, and that there are differences in imaging findings when comparing PTH to healthy controls and when comparing PTH to migraine. Although it is not entirely clear if the imaging findings are directly attributable to PTH as opposed to the underlying TBI or other post-TBI symptoms, correlations between the imaging findings with headache frequency and headache resolution suggest a true relationship between the imaging findings and PTH. PTH attributed to mTBI is associated with abnormalities in brain structure and function that can be detected via research imaging. Additional studies are needed to determine the specificity of the findings for PTH, to differentiate findings attributed to PTH from those attributed to the underlying TBI and coexistent post-TBI symptoms, and to determine the accuracy of imaging findings for predicting the development of PPTH.
根据定义，归因于轻度创伤性脑损伤（mTBI）的创伤后头痛（PTH）与脑部影像常规临床检查中所见的脑结构异常无关。然而，通过研究成像技术检测到的细微脑结构异常以及功能异常，为深入了解PTH的病理生理学提供了线索。本文的目的是总结已发表的关于mTBI所致PTH脑部研究成像的结果。对于这篇叙述性综述，我们在PubMed上使用“创伤后头痛”或“脑震荡后头痛”以及“成像”或“磁共振成像”或“研究成像”或“正电子发射断层扫描”等术语进行搜索。根据文章与主题的相关性选择纳入的文章。最终，本综述纳入了10篇文章。这些研究调查了急性PTH中的白质束完整性和功能连接性、持续性PTH（PPTH）中的结构测量、白质束完整性、脑血流量和功能连接性，以及急性和持续性PTH中的质子波谱。这些文章表明，急性和持续性PTH与脑结构异常有关，急性和持续性PTH也与脑功能异常有关，利用脑成像结果有可能预测PTH的持续性，并且在将PTH与健康对照进行比较以及将PTH与偏头痛进行比较时，成像结果存在差异。尽管尚不完全清楚成像结果是否直接归因于PTH，而非潜在的TBI或其他TBI后症状，但成像结果与头痛频率和头痛缓解之间的相关性表明成像结果与PTH之间存在真实关联。mTBI所致PTH与可通过研究成像检测到的脑结构和功能异常有关。需要进一步的研究来确定这些发现对PTH的特异性，将归因于PTH的发现与归因于潜在TBI和共存的TBI后症状的发现区分开来，并确定成像结果预测PPTH发生的准确性。
