Migraine and Headache After Trauma – Post Traumatic Headache (PTH)
Headache is the most common symptom after a head injury. Post traumatic headaches, like non traumatic migraine and tension headache for some reason pose a significant challenge for clinicians and are surrounded by controversy. Because the neurological examination after mild head injury is normal and standard tests as well as imaging studies (such as MRI or CT of the head) fail to reveal abnormalities, it is often thought that the symptoms following mild head injury are psychological.
Why is it then that in the presence of any abnormal findings the focus on the head continues?
It is important that after a blow to the head an intracranial (within the head) cause of headache or migraine be ruled out. However once an intracranial cause has been eliminated, why then does the source of the headache or migraine become such a mystery?
If the head hits the windscreen for example, the body keeps moving; it is the neck which connects the head to a moving body and absorbs a significant amount of stress.
It is very important then that a skilled examination of the upper three spinal segments be performed and that prior to examination of the upper neck, assessment of crucial ligaments be undertaken – this is mandatory.
An examination of this nature may prevent years of frustration and unnecessary medication.
Cheers
Dean
Consultant Headache and Migraine Physiotherapist; Adjunct Lecturer, Masters Program, School of Physiotherapy, University of South Australia; PhD Candidate, Murdoch University, Western Australia
Headache Migraine
References:
(Packard RC. Chronic Post-traumatic headache: Associations with mild traumatic brain injury, concussion, and post-concussive disorder. Current Pain and Headache Reports 2008; (12)1:67-73
Treleaven J, Jull G, Atkinson L. Cervical musculoskeletal dysfunction in post-concussional headache. Cephalalgia 1994;14:273-9)
