MANAGEMENT OF POSTTRAUMATIC HEADACHE FOLL OWING HEAD TRAUMA AND WHIPLASH INJURY - GUIDELINES OF THE GERMAN-MIGRAINE-AND-HEADACHE-SOCIETY

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.