M. Keidel et al., MANAGEMENT OF POSTTRAUMATIC HEADACHE FOLL OWING HEAD TRAUMA AND WHIPLASH INJURY - GUIDELINES OF THE GERMAN-MIGRAINE-AND-HEADACHE-SOCIETY, Nervenheilkunde, 17(1), 1998, pp. 36-47
Head trauma (HT) and whiplash injury (WI) are followed by a posttrauma
tic headache (PH) in approx. 90% of patients. The PH due to common WI
is located occipitally (67%), is of dull-pressing or dragging characte
r (77%) and lasts on average 3 weeks. Tension headache is the most fre
quent type of PH (85%). Besides posttraumatic cervicogenic headache or
symptomatic, secondary headache due to epi-or subdural hematoma, due
to subarachnoidal or intracerebral bleeding or due to an increased int
racranial pressure, migraine-or cluster-like headache can be observed
in rare cases. Prolonged application of analgetics (>4 weeks) can caus
e a drug induced headache. In 80% of patients PH following HT shows re
mission within 6 months. Chronic PH lasting at least 4 years occurs in
20%. It should not occur, that a secondary, symptomatic headache (e.g
. due to fracture or intracranial bleeding) is overseen. Acute PH is t
reated with analgesics, antiphlogistics and/or muscle relaxants; chron
ic PH with thymoleptics (e.g. Amitryptiline or Amitryptiline oxide). A
dditional physical therapy (e.g. wearing a cervical collar for a short
time, hydrocollator pack), physiotherapy incl. muscle relaxation tech
niques (Jacobson) and psychotherapy can be performed. The development
of a drug induced headache has to be prevented by a controlled and sho
rt-lasting prescription of analgetics and by narrow timed reexaminatio
ns of the patient.