Research Roundup – Post Traumatic Headaches (PTH)

Headaches are one of the most common symptoms following a traumatic brain injury, but can the evidence indicate the best way to treat them? In this article, Headway Clinical Psychologist Claire McMoreland reviews the literature…

Headaches are one of the most commonly reported symptoms after a traumatic brain injury (TBI). Those that develop as a result of an injury are called Post-traumatic headaches (PTH). The types of headaches experienced after TBI share similar characteristics with other types of headaches, and can be further categorised into for example, migraine or tension-type headache.

Reports vary on how common headaches are after brain injury. Some studies report up to 90% of people developing headache following TBI. A study conducted by Walker et al. (2005) of 109 war veterans in the US established a 38% prevalence rate of PTH in the first year following TBI, and of those, almost all reported daily headache. Other studies show that risk factors for developing PTH include being female, having a history of repeated brain injury, and having a pre-existing history of headache. Studies also indicate that PTH is more common in mild than severe TBI.

PTH is considered chronic when symptoms persist for three months or longer. Chronic PTH is associated with poorer outcomes and cognitive issues such as memory difficulties and reduced processing speed. Migraine has also been associated with a longer recovery time after injury.

The adequate and accurate treatment of headaches following brain injury is important in order to prevent headaches becoming chronic. Currently however, there is insufficient evidence as to the best way to treat headaches after injury. Conducting research into posttraumatic headaches is difficult to do because there are many different types of headaches. There are also many causes of headaches following brain injury – for example, damage to the skull or brain tissue, muscular injury, or injuries to the cervical spine or peripheral nerves can all cause headaches. One recent article by Mayer et al. (2013) on migraine post-TBI has suggested that a neuroinflammatory response could be behind the development of migraine following brain injury. They propose that after the initial injury to the brain tissue, inflammation occurs in an attempt to defend the brain against further damage and to help repair damaged brain tissue. When this response persists however, changes in the brain may result in neurological symptoms such as headaches.

Very few rigorous studies have been conducted on the treatment of PTH. In a systematic review of 36 articles conducted by Watanabe et al., (2012), this issue was further highlighted. From the studies identified, the authors were unable to come to definitive conclusions on the best interventions for PTH. The studies they did include in their review employed different approaches. These included drug or biologically-based interventions such as physical therapy, medication, and biofeedback; and behavioural interventions such as Cognitive Behaviour Therapy (CBT) and psychoeducation on headaches. In one study of the effectiveness of CBT for chronic PTH, overall improvements in the intensity, frequency of headaches, and overall emotional wellbeing was reported. As a guideline to future researchers, the authors emphasise the importance of diagnosing the specific type of headache since this will allow research to be directed towards different presentations of headache, their underlying cause, and identifying the most effective interventions.

Given the lack of information on the cause and treatment for PTH, headaches following a brain injury are currently treated in the same way as non-TBI related headaches. The Migraine Association of Ireland website at www.migraine.ie provides information and support to people suffering from migraine. This advice may also be helpful to those suffering from post-traumatic migraine. The website stresses the importance of getting to know your migraine triggers, such as diet, hormonal changes, stress, or environmental factors. Keeping a diary of headaches will help to identify patterns of migraine and their severity and frequency. The website also offers advice on strategies for managing migraine through stress management, exercise, medication and adopting a structured lifestyle.

References:

Mayer, C. L., Huber, B. R., & Peskind, E. (2013). Traumatic Brain Injury, Neuroinflammation, and Post-Traumatic Headaches. Headaches, 1523-1530.

Walker, W. C., Seel, R. T., Curtiss, G., & Warden, D. L. (2005). Headache after Moderate and Severe Traumatic Brain Injury: A Longitudinal Analysis. Archives of Physical Medicine and Rehabilitation, 86, 1793-1800.

Watanabe, T. K., Bell, K. T., Walker, W. C., & Schomer, K. (2012). Systematic Review of Interventions for Posttraumatic Headache. American Academy of Physical Medicine and Rehabilitation

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