Division of Vascular Medicine and Pharmacology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Health Sciences Department, University of Florence, and Headache Centre, Careggi University Hospital, Florence, Italy.
J Headache Pain. 2020 May 24;21(1):55. doi: 10.1186/s10194-020-01122-5.
Headache is a common complication of traumatic brain injury. The International Headache Society defines post-traumatic headache as a secondary headache attributed to trauma or injury to the head that develops within seven days following trauma. Acute post-traumatic headache resolves after 3 months, but persistent post-traumatic headache usually lasts much longer and accounts for 4% of all secondary headache disorders.
The clinical features of post-traumatic headache after traumatic brain injury resemble various types of primary headaches and the most frequent are migraine-like or tension-type-like phenotypes. The neuroimaging studies that have compared persistent post-traumatic headache and migraine found different structural and functional brain changes, although migraine and post-traumatic headache may be clinically similar. Therapy of various clinical phenotypes of post-traumatic headache almost entirely mirrors the therapy of the corresponding primary headache and are currently based on expert opinion rather than scientific evidence. Pharmacologic therapies include both abortive and prophylactic agents with prophylaxis targeting comorbidities, especially impaired sleep and post-traumatic disorder. There are also effective options for non-pharmacologic therapy of post-traumatic headache, including cognitive-behavioral approaches, onabotulinum toxin injections, life-style considerations, etc. CONCLUSION: Notwithstanding some phenotypic similarities, persistent post-traumatic headache after traumatic brain injury, is considered a separate phenomenon from migraine but available data is inconclusive. High-quality studies are further required to investigate the pathophysiological mechanisms of this secondary headache, in order to identify new targets for treatment and to prevent disability.
头痛是颅脑损伤的常见并发症。国际头痛协会将创伤后头痛定义为继发于头部创伤或损伤的头痛，在创伤后 7 天内发生。急性创伤后头痛在 3 个月后缓解，但持续性创伤后头痛通常持续时间更长，占继发性头痛疾病的 4%。
颅脑损伤后创伤后头痛的临床特征类似于各种原发性头痛，最常见的是偏头痛样或紧张型样表型。比较持续性创伤后头痛和偏头痛的神经影像学研究发现了不同的结构和功能脑变化，尽管偏头痛和创伤后头痛在临床上可能相似。各种创伤后头痛临床表型的治疗几乎完全反映了相应原发性头痛的治疗，目前基于专家意见而不是科学证据。药物治疗包括发作性和预防性药物，预防针对合并症，特别是睡眠障碍和创伤后障碍。创伤后头痛的非药物治疗也有有效选择，包括认知行为方法、肉毒杆菌毒素注射、生活方式考虑等。
尽管存在一些表型相似性，但颅脑损伤后持续性创伤后头痛被认为是一种与偏头痛不同的现象，但现有数据尚无定论。需要进一步开展高质量研究，以探讨这种继发性头痛的病理生理机制，从而为治疗和预防残疾确定新的靶点。
