Headache is the commonest neurological symptom of Mild Traumatic Brain Injury.
| PRACTICE
POINT Both psychological factors and physical disruptions of the brain contribute to the occurance and severity of Post-Traumatic Headache |
Hitherto, much of the research[1], [2], [3] on Chronic Post-Traumatic Headache (CPTH) has focused on psychological factors[7] including so-called Compensation Neurosis. However, as reported in Medical Litigation News Volume 2, Issue 2, settlement of claims does not cure CPTH.
Three-quarters of cases referred to a psychological service for PTH fulfilled the criteria for Post Traumatic Stress Disorder (PTSD, Medical Litigation News Volume 1, Issue 4, and Volume 2, Issue 10), and a third had a pre-accident psychiatric disorder[1].
PRACTICE POINT Chronic Post-Traumatic Headache clients require psychiatric assessment for 1.
Post-Traumatic Stress Disorder |
An early Italian study noted psychological abnormalities identical with those found in sufferers from common headache[3].
In three-quarters of sufferers, the clinical characteristics of CPTH are indistinguishable from Chronic Tension-Type headaches, whereas most of the remainder simulate Migraine without Aura[4]. As noted in Whiplash 1995-6, Medical Litigation News Volume 2, Issue 2, clinical SPECT scanning has demonstrated diminished blood flow to the parietal-occipital region of the brain in severe Late Whiplash Syndrome.
Recent experimental studies[5] of blood flow to different regions of the brain after inhaling radioactive gas have similarly shown both reduction and asymmetry in sufferers from Chronic PTH.
Although these reductions in blood-flow are not seen in sufferers from Migraine, the many biochemical changes previously documented in migraineurs have now also been found in PTH[6].
PRACTICE POINT Chronic Post-Traumatic Headache has been shown experimentally to be accompanied by disturbances of regional blood-supply and biochemistry in the brain |
Can MTBI and Cervical Whiplash trigger the de novo onset of Migraine? Previously proposed criteria[7] for the phenomenon could be used to establish Medical Causation.
| PRACTICE POINT 1. onset
immediate of within the first few days |
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