Department of Anatomy, Physiology and Genetics, Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA.
Cells. 2022 Dec 30;12(1):155. doi: 10.3390/cells12010155.
Posttraumatic headache (PTH) attributed to traumatic brain injury (TBI) is a secondary headache developed within 7 days after head injury, and in a substantial number of patients PTH becomes chronic and lasts for more than 3 months. Current medications are almost entirely relied on the treatment of primary headache such as migraine, due to its migraine-like phenotype and the limited understanding on the PTH pathogenic mechanisms. To this end, increasing preclinical studies have been conducted in the last decade. We focus in this review on the trigeminovascular system from the animal studies since it provides the primary nociceptive sensory afferents innervating the head and face region, and the pathological changes in the trigeminal pathway are thought to play a key role in the development of PTH. In addition to the pathologies, PTH-like behaviors induced by TBI and further exacerbated by nitroglycerin, a general headache inducer through vasodilation are reviewed. We will overview the current pharmacotherapies including calcitonin gene-related peptide (CGRP) monoclonal antibody and sumatriptan in the PTH animal models. Given that modulation of the endocannabinoid (eCB) system has been well-documented in the treatment of migraine and TBI, the therapeutic potential of eCB in PTH will also be discussed.
创伤后头痛(PTH)归因于创伤性脑损伤(TBI),是头部受伤后 7 天内发生的继发性头痛,在大量患者中,PTH 成为慢性头痛,持续时间超过 3 个月。目前的药物治疗几乎完全依赖于偏头痛等原发性头痛的治疗,这是由于其偏头痛样表型以及对 PTH 发病机制的了解有限。为此,在过去十年中进行了越来越多的临床前研究。我们在这篇综述中重点关注动物研究中的三叉神经血管系统,因为它提供了支配头部和面部区域的主要伤害性感觉传入神经,并且认为三叉神经通路的病理变化在 PTH 的发展中起着关键作用。除了病理学,我们还回顾了 TBI 引起的类似 PTH 的行为,以及通过血管扩张作为一般头痛诱导剂的硝化甘油进一步加重的类似 PTH 的行为。我们将综述目前在 PTH 动物模型中使用的药物治疗方法,包括降钙素基因相关肽(CGRP)单克隆抗体和舒马曲坦。鉴于内源性大麻素(eCB)系统的调节在偏头痛和 TBI 的治疗中已有很好的记录,因此也将讨论 eCB 在 PTH 中的治疗潜力。