Post-traumatic headache

Abstract

Head trauma (HT) and whiplash injury (WI) is followed by a posttraumatic headache (PH) in approx. 90% of patients. The PH due to common WI is located occipitally (67%), is of dull-pressing or dragging character (77%) and lasts on average 3 weeks. Tension headache is the most frequent type of PH (85%). Besides posttraumatic cervicogenic headache or symptomatic, secondary headache due to SDH, SAB, ICB or increased ICP, migraine- or cluster-like headache can be observed in rare cases. Prolonged application of analgetics (> 4 weeks) can cause a drug induced headache. In 80% of patients PH following HT shows remission within 6 months. Chronic PH lasting at least 4 years occurs in 20%. Unfavorouble prognostic factors include an age higher than 40 yrs, a low intellectual, educational and socio-economic level, previous HT or a history of alcohol abuse. A prolonged PH due to WI can be expected in patients with initially severe headache, with an extensive decrease of mobility of the cervical spine, with subjective impediment, with depressive mood, with somatic-vegetative complaints, with a history of pretraumatic headache and with increased age. Acute PH is treated with analgesics, antiphlogistics and/or muscle relaxants; chronic PH with thymoleptics (e.g. Amitryptiline or Amitryptiline oxide). Additional physical therapy (e.g. wearing a cervical collar for a short time, hydrocollator pack), physiotherapy incl. muscle relaxation techniques (Jacobson) and psychotherapy can be performed. Medico-legal issues should be solved as soon as possible.