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Curr Neurol Neurosci Rep (2014) 14:428
DOI 10.1007/s11910-013-0428-2
HEADACHE (R HALKER, SECTION EDITOR)
Insights and Advances in Post-traumatic Headache: Research Considerations
Teshamae S. Monteith & David Borsook
Published online: 17 January 2014# Springer Science+Business Media New York 2014
Abstract Despite the growing awareness of mild traumatic brain injury in military and civilian populations, understanding of the acute and chronic effects of concussion on central nervous system structure and function is limited. Even less is understood about the underpinnings of the cardinal postconcussive symptom, post-traumatic headache (PTH). Here, we review recent advances in PTH, with special emphasis on the migraine-like phenotype, the most disabling form. Considerations for future research in PTH are discussed, including diagnostic classification, and applications with advanced neuroimaging techniques, biomarkers, and treatments.
Keywords Post-traumatic headache . Concussion . Mild traumatic brain injury . Imaging . Epidemiology . Diagnosis . Migraine . Risk factors . Biomarkers . Military . Athletes . Youth sports
Introduction
Traumatic brain injury (TBI) is a problem of epidemic proportions in both civilian and military populations. More recently, a rising recognition of acute and persistent consequences of mild TBI in military servicemen and women, professional athletes(i.e., National Football League players) and school-age players
has made concussion a subject of increased focus, mainstream attention, and research priority. According to the Center For Disease Control and Prevention, at least 1.7 million TBIs occur annually [1], 75 % of which are concussions or mild TBIs [2]. Postconcussive syndrome is diagnosed by evidence of cerebral dysfunction and a myriad of physiological and neuropsychiatric disturbances. Headache is one of the most common symptoms experienced after a head injury [3], and repetitive injury, female gender, and pre-existing history of migraine are risk factors for chronic headache [4]. We pay particular attention to the migraine-like phenotype of PTH and discuss its implications. Taken together, migraine is a neurovascular condition defined by attacks of moderate-to-severe headache in addition to particular sensitivities (lights, sounds, odors, movements) and/or gastrointestinal symptoms(i.e., nausea, vomiting). Moreover, migraine is a disorder characterized by changes in brain states and multi-system disturbances (i.e., emotional, cognitive, autonomic, vestibular dys-function), which may, conceivably, predispose an individual to more symptomatology in the setting of a traumatized brain.
Despite the evidence for concussion, the presence of co-morbid psychiatric disorders,...