Symptomatic approach to posttraumatic headache and its possible implications for treatment

We investigated 112 patients (mean age 39.5+/-10.5 years, 59% women (n=66)] with chronic posttraumatic headache following cranio-cervical acceleration /deceleration trauma after an average time interval of 2.5+/-1.9 years from trauma. Headache following minor head injury or whiplash is one of the mos t prominent problems in neurotraumatology. Previous research is inconclusiv e regarding the symptomatic approach of this type of headache. Details of t he phenomenology of posttraumatic headache in the previous literature are i nconclusive. This may lead to inappropriate treatment strategies, because r ecent advances in therapy of different headache types may be neglected. Pat ients were investigated at the outpatient service of the Department of Psyc hiatry. Headache was analyzed according to its principal location, laterali ty, projection, quality, precipitation or aggravation and possible addition al symptoms. For this analysis, headache was diagnosed according to the cla ssification of the International Headache Society. The results showed that 42 patients (37%) had tension-type headache, 30 (27%) were identified as su ffering from migraine, whereas 20 patients (18%) had cervicogenic headache. An additional 18% of patients suffered from headache that did not fulfill criteria of a particular category. In 104 patients (93%), neck pain was ass ociated in time with headache. Each of the diagnosed headache types in this study may require specific treatment strategies based upon empirical studi es of non-traumatic headache types. For these reasons a detailed analysis o f headache following cranio-cervical acceleration/deceleration trauma is ne cessary.