Posttraumatic Headaches after Injuries to the Skull, Brain and Cervical Spine
Mann mit Schmerz verzerrtem GesichtJames Group Studios - Fotolia

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Progression

Young patients with a very light concussion, e.g., without losing consciousness, recover from an accident within a few days. As a rule, the classic “concussion patient,” with a brief period of unconsciousness and a mental blackout of less than 60 minutes, completely recovers within 6-12 weeks.

In most cases, the posttraumatic syndrome after a severe concussion remits within a couple of months to a couple of years. After half a year, more than 80 % of patients are headache-free after a concussion. The effect of a social stress situation at the time of the accident on the course of the medical condition is discussed with great controversy.

About 20 % of patients with a concussion still suffer headaches four years after the trauma. 10 % - 15 % of patients do not show complete healing of the posttraumatic syndrome, which can persist in the form of headaches, neck pains, vertigo, verifiable neuropsychological deficits and disorders of the mental state.

Clinic

In 90 % of cases, concussions and cervical spine whiplash injuries are followed by a posttraumatic headache. The posttraumatic headache may manifest itself with varying characteristics. Symptoms range from headaches with the characteristics of a tension headache, migraine headache, cluster headache, cervicogenic headache to secondary headaches.

In 85 % of cases, tension headaches are the most common type of posttraumatic headaches. Aside from the cervicogenic headache and the secondary headache (in case of an intracranial hemorrhage), in rare cases, posttraumatic headaches similar to migraines or cluster headaches are possible. If, in the case of acute posttraumatic headaches, analgesics are administered for more than four weeks, a medication-induced permanent headache may develop.

Typology of possible forms of posttraumatic headaches

  • Tension-type headaches (85 %)
  • Cervicogenic headache
  • Migraine-type headaches
  • Cluster-type headaches
  • Local headaches in case of skin/bone injuries

 

Posttraumatic Headache of the Tension Type

According to health clinics and the IHS criteria, tension headaches are the most common form of posttraumatic headaches, and are characterized by a dull-oppressive, dragging or pressing pain, which, in most cases, favors the neck in a strip or helmet-shaped fashion and occurs continuously. In rare cases, it appears in episodic fashion. The headache usually only appears after a complaint-free interval of several hours to one day, on average about five hours after the whiplash.

Posttraumatic Cervicogenic Headache

The posttraumatic cervicogenic headache must be clinically differentiated from other types. Although it also favors the neck, it typically radiates from the back to the front, is characterized by dragging pain, and is not present in the entire head, but unilaterally. It does not change sides.

In order to confirm a diagnosis, a reproducible mechanic provocation of the headache through defined head positions as well as increased pressure pain sensitivity to a particular cranial nerve exit point is required. The diagnosis is supported by the consequences of bone injuries at the cervical spine related to the trauma.

Posttraumatic Headaches of the Migraine Type

Posttraumatic headaches of the migraine type also manifests themselves unilaterally, but in most cases change sides, and, as a rule, does not possess a dull-oppressing or dragging-type pain, but a pulsating-type pain. The intensity of the pain increases with physical activity. Accompanying vegetative symptoms such as nausea, vomiting, or dizziness, combined with photophobia and phonophobia, are common. Headaches of the migraine type may involve an aura with neurological stimuli and/or deficits.

Posttraumatic Headache of the Cluster Type

Cluster type posttraumatic headaches do not differ clinically from primary cluster headaches, but are harder to soothe through treatment. Foremost among complaints for this kind of headache are a unilateral, oppressive or pulsating headache and facial pain favoring the eyes, accompanied by local symptoms related to the eyes (red eye, watering eye, hanging eyelid).

Medication-Induced Headache

When patients take analgesics over a longer period of time due to an acute posttraumatic headache and/or do so unchecked, a medication-induced, permanent headache may develop. This may manifest itself after only four weeks of continuous analgesics, but usually only appears after several years of (in most cases) improper consumption of pain killers. Medication-induced permanent headaches occur on a daily basis, are already present in the morning, are characterized by a dull-oppressive pain, spread across the entire head and intensify with physical exertion.

Therapy

Therapy depends on the cause and the type of headache and is best provided in a center specializing in headache patients!

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