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Characteristics and Treatment of Headache After Traumatic Brain Injury: A Focused Review

Lew, Henry L. MD, PhD; Lin, Pei-Hsin MD; Fuh, Jong-Ling MD; Wang, Shuu-Jiun MD; Clark, David J. MD, PhD; Walker, William C. MD

American Journal of Physical Medicine & Rehabilitation: July 2006 - Volume 85 - Issue 7 - pp 619-627
doi: 10.1097/01.phm.0000223235.09931.c0
Invited Review: Brain Injury

Lew HL, Lin P-H, Fuh J-L, Wang S-J, Clark DJ, Walker WC: Characteristics and treatment of headache after traumatic brain injury: A focused review. Am J Phys Med Rehabil 2006;85:619–627.

Headache is one of the most common complaints in patients with traumatic brain injury. By definition, headache that develops within 1 wk after head trauma (or within 1 wk after regaining consciousness) is referred to as posttraumatic headache (PTH). Although most PTH resolves within 6–12 mos after injury, approximately 18–33% of PTH persists beyond 1 yr. We performed a systematic literature review on this topic and found that many patients with PTH had clinical presentations very similar to tension-type headache (37% of all PTH) and migraine (29% of all PTH). Although there is no universally accepted protocol for treating PTH, many clinicians treat PTH as if they were managing primary headache. As a result of the heterogeneity in the terminology and paucity in prospective, well-controlled studies in this field, there is a definite need for conducting double-blind, placebo-controlled treatment trials in patients with PTH.

From the Veterans Affairs Palo Alto Health Care System, Palo Alto, California (HLL, DJC); Stanford University School of Medicine, Stanford, California (HLL, DJC); Harvard School of Public Health, Boston, Massachusetts (P-HL); The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan (J-LF, S-JW); the National Yang-Ming University Schools of Medicine, Taipei, Taiwan (J-LF, S-JW); and Hunter McGuire VAMC, Richmond, Virginia (WCW).

All correspondence and requests for reprints should be addressed to Pei-Hsin Lin, MD, Harvard School of Public Health, 677 Huntington Avenue, Boston MA 02115.

© 2006 Lippincott Williams & Wilkins, Inc.