Exploring naturally occurring clinical subgroups of post-traumatic headache


  • Heather Mason
  • Univadis Medical News
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Headache is common following injury to the head or neck. While most post-traumatic headaches (PTH) resolve within 3-6 months, 18-22 per cent last for over a year and little is known about its pathophysiology.

A retrospective study of adult patients (n=300) with a diagnosis of post-traumatic headache (PTH), explored the clinical predictors that may be more likely associated with persistent (n=150) versus acute (n=150) PTH.
 
Predictor variables revealed that in persistent PTH patients, 59 (40%) had a history of migraine, 37 (25%) had repeated injury, 32 (21%) lost consciousness, 58 (39%) had medication overuse, 78 (52%) had a pre-existing psychological history and 147 (98%) new PTH-associated comorbidities.

Of the acute PTH patients, eight (5%) had migraine history, eight (5%) had repeated injury, 12 (8%) lost consciousness, one had medicine overuse, 27 (18%) had a psychological history and 103 (69%) had new PTH-associated comorbidities.
 
While all patients with acute PTH resolved within three months, only five persistent PTH patients had complete resolution.
 
Pre-existing psychological history, history of migraine, new PTH-associated comorbidities and medication overuse predicted the occurrence of persistent PTH as well as two naturally occurring PTH clusters correlating to acute and persistent PTH. Management emphasis should focus on these phenotypes.