References: Traumatic Headache; Volume 3 Issue 7

1. AUTHOR	Hickling-E-J, Blanchard-E-B, Silverman-D-J, Schwarz-S-P.
INSTITUTION	Capital Psychological Associates, Albany, NY 12208.
TITLE	Motor vehicle accidents, headaches and post-traumatic stress disorder: assessment findings in a consecutive series.
SOURCE	Headache 1992 Mar, VOL: 32 (3), P: 147-51, ISSN: 0017-8748.
ABSTRACT	Results of 20 consecutive cases referred for post-traumatic headache (PT-HA) to a psychological practice were assessed for both psychiatric and neurological diagnoses. Nineteen of the 20 cases (95%) had a diagnosable psychiatric disorder, with 15 presenting with a post-traumatic stress disorder. Prior headache history was reported for only 25% of the referred patients, while a prior psychiatric disorder was found for 7 (35%) of the cases. Findings suggest that consideration of a psychiatric disorder should be made for PT-HA patients. Author.

2. AUTHOR	De-Benedittis-G, De-Santis-A.
INSTITUTION	Institute of Neurosurgery, University of Milan, Italy.
TITLE	Chronic post-traumatic headache: clinical, psychopathological features and outcome determinants.
SOURCE	J-Neurosurg-Sci 1983 Jul-Sep, VOL: 27 (3), P: 177-86, ISSN: 0390-5616.
ABSTRACT	The epidemiological and clinical profile of Chronic Post-Traumatic Headache (CPTH) has been studied in 57 out of 130 consecutive patients hospitalized, following closed head injuries, at the Institute of Neurosurgery of the University of Milan. The incidence of CPTH has been 44%. Age of the patients ranged between 4 and 69 years. Clinical pictures included closed head injuries of different degree of severity: mild, moderate and severe. Time of onset, headache frequency, character, intensity, duration and associated symptoms showed a great degree of variability. However, chronic muscle contraction headache was the commonest clinical syndrome followed by migraine. Moderate correlations have been found between the severity of CPTH disturbance of consciousness, following the head trauma, and positive findings at CT scan. Moreover the comparison of personality profiles (MMPI) of CPTH (n=26) with a post-traumatic control group, without headache (n=17) showed higher scores on hypocondriasis, depression, hysteria and schizophrenia scales only in the severe CPTH group. Age of the patients, duration of unconsciousness, neurological deficits, course length and pending litigation or compensations were unrelated to the occurrence and outcome of CPTH. These findings suggest the importance of both physical and psychological determinants (social or emotional maladjustment) in the pathogenesis of CPTH. Author.

3. AUTHOR	Fioravanti-M, Ramelli-L, Napoleoni-A, Lazzari-R, Ruggieri-S, Cerbo-R, Formisano-R, Grillo-G, Feliciani-M, Agnoli-A, et-al.
INSTITUTION	Institute of Psychology, School of Medicine, University of Rome, Italy.
TITLE	Post-traumatic headache: neuropsychological and clinical aspects.
SOURCE	Cephalalgia 1983 Aug, VOL: 3 Suppl 1, P: 221-4, ISSN: 0333-1024.
ABSTRACT	Seventy patients suffering from post-traumatic headache were studied. Pain characteristics, personality and intellectual functions were assessed to be related to cranial trauma. No evident signs of brain damage were present, but an impairment related to pain in personal adjustment and well-being reducing work and study capabilities was identified. A psychopathological condition described as anxiety with somatizations and conversion mechanisms was found and when compared with the psychopathological characteristics from a group of common headache patients no differences were obtained between the two groups. DSM III diagnostic possibilities for post-traumatic headache patients were discussed. Author.

4. AUTHOR	Haas-D-C.
INSTITUTION	Department of Neurology, State University of New York Health Science Center at Syracuse, USA.
TITLE	Chronic post-traumatic headaches classified and compared with natural headaches (see comments).
SOURCE	Cephalalgia 1996 Nov, VOL: 16 (7), P: 486-93, ISSN: 0333-1024. CM Comment in: Cephalalgia 1996 Nov; 16(7 ):461.
ABSTRACT	This study sought to determine whether chronic post-traumatic headaches are different from or identical to the naturally occurring headaches. The chronic post-traumatic headaches of 48 patients were classified, as if they were natural headaches, by the diagnostic criteria of the International Headache Society. Thirty-six patients' headaches (75%) were chronic tension-type headache, 10 (21%) were migraine without aura, and 2 (4%) were unclassifiable. The characteristics and accompaniments of the headaches within each diagnostic group were then compared to those in a control group with natural headaches of the same type. No notable differences between the post-traumatic and control groups were found. Hence, chronic post-traumatic headaches have no special features, but are symptomatically identical to either chronic tension-type headache or migraine without aura (in this series of patients). This identity suggests that post-traumatic headaches are generated by the same processes causing the natural headaches, not by intracranial derangement from head blows or jolts. Author.

5. AUTHOR	Gilkey-S-J, Ramadan-N-M, Aurora-T-K, Welch-K-M.
INSTITUTION	Department of Neurology, Henry Ford Hospital and Health Sciences Center, Detroit, Mich., USA.
TITLE	Cerebral blood flow in chronic posttraumatic headache.
SOURCE	Headache 1997 Oct, VOL: 37 (9), P: 583-7, ISSN: 0017-8748.
ABSTRACT	BACKGROUND AND PURPOSE: Headache is the most common neurologic symptom following minor closed head injury. There is often a lack of objective evidence supporting an organic basis of cerebral pathology in these cases. This pilot study considers the possibility of alterations in cerebral blood flow, indicating evidence of an organic disorder in posttraumatic headache. METHODS: Regional cerebral blood flow studies of 35 patients with chronic posttraumatic headache (PTH) (International Headache Society criteria), identified retrospectively from our cerebral blood flow data base, were compared with those of 49 nonheadache controls and 92 migraineurs (Ad Hoc Committee criteria). Regional cerebral blood flow (initial slope index method) was measured using the xenon Xe 133 inhalation technique. RESULTS: Compared to migraineurs and controls, and after adjusting for differences (analysis of covariance) in baseline variables such as blood pressure, hematocrit, and PCO2, patients with PTH had: (1) significantly lower mean initial slope indices (P < 0.001, P = 0.002, respectively); (2) regional interhemispheric flow differences (rIFD), with higher distribution of regional asymmetrical probe pairs (rIFD > or = 7%: P(PTH versus control) = 0.006, P(PTH versus migraine) = 0.016: rIFD > or = 10%; P(PTH versus control) = 0.011, P(PTH versus migraine) = 0.003); and (3) more hemispheric asymmetries (P(PTH versus control) = 0.023, P(PTH versus migraine) = 0.57). Lower mean initial slope indices and hemispheric asymmetry (mean interhemispheric flow difference > or = 3.2%) predicted PTH over control (P = 0.023 and 0.002, respectively). Lower mean initial slope indices predicted PTH over migraine (P = 0.002). CONCLUSIONS: Patients with PTH have reduced regional cerebral blood flow, and regional and hemispheric asymmetries. These cerebral hemodynamic alterations support an organic basis to chronic posttraumatic headache. Author.

6. AUTHOR	Packard-R-C, Ham-L-P.
INSTITUTION	Headache Management and Neurology, Pensacola, FL 32503, USA.
TITLE	Pathogenesis of posttraumatic headache and migraine: a common headache pathway?
SOURCE	Headache 1997 Mar, VOL: 37 (3), P: 142-52, ISSN: 0017-8748 114 Refs.
ABSTRACT	In recent years, research implicating biochemical abnormalities in various pathological conditions has spiralled. Headache is an area in which numerous research studies have been conducted examining biochemical alterations. We have noticed several similarities in biochemical changes reported to occur in migraine and in experimental traumatic brain injury. The most common symptom in mild head injury or mild traumatic brain injury is headache which, in many instances, resembles migraine but has a poorly understood pathophysiology. Biochemical mechanisms believed to be similar in both conditions include: increased extracellular potassium and intracellular sodium, calcium, and chloride; excessive release of excitatory amino acids; alterations in serotonin; abnormalities in catecholamines and endogenous opioids; decline in magnesium levels and increase in intracellular calcium; impaired glucose utilization; abnormalities in nitric oxide formation and function; and alterations in neuropeptides. In this paper, these proposed biochemical alterations will be reviewed and compared. Very similar alterations suggest posttraumatic headache associated with mild head injury and migraine may share a common headache pathway. Author.

7. AUTHOR	Weiss-H-D, Stern-B-J, Goldberg-J.
INSTITUTION	Department of Medicine, Sinai Hospital, Baltimore, Maryland 21215.
TITLE	Post-traumatic migraine: chronic migraine precipitated by minor head or neck trauma (see comments).
SOURCE	Headache 1991 Jul, VOL: 31 (7), P: 451-6, ISSN: 0017-8748. CM Comment in: Headache 1992 Mar; 32(3):157-8.
ABSTRACT	Minor trauma to the head or neck is occasionally followed by severe chronic headaches. We have evaluated 35 adults (27 women, 8 men) with no prior history of headaches, who developed recurrent episodic attacks typical of common or classic migraine following minor head or neck injuries ("post-traumatic migraine"-PTM). The median age of these patients was 38 years (range 17 to 63 years), which is older than the usual age at onset of idiopathic migraine. The trauma was relatively minor: 14 patients experienced head trauma with brief loss of consciousness, 14 patients sustained head trauma without loss of consciousness, and 7 patients had a "whiplash" neck injury with no documented head trauma. Headaches began immediately or within the first few days after the injury. PTM typically recurred several times per week and was often incapacitating. The patients had been unsuccessfully treated by other physicians, and there was a median delay of 4 months (range 1 to 30 months) before the diagnosis of PTM was suspected. The response to prophylactic anti-migraine medication (propranolol or amitriptyline used alone or in combination) was gratifying, with 21 of 30 adequately treated patients (70%) reporting dramatic reduction in the frequency and severity of their headaches. Improvement was noted in 18 of the 23 patients (78%) who were still involved in litigation at the time of treatment. The neurologic literature has placed excessive emphasis on compensation neurosis and psychological factors in the etiology of chronic headaches after minor trauma. Physicians must be aware of PTM, as it is both common and treatable. Author.