Addressing Specific Factors Contributing to Post-Traumatic Headache

During a session at the 2018 Scottsdale Headache Symposium, Bert Vargas, MD, identified and addressed specific and individualized issues and contributory factors that trigger PTH, and explained how these factors aid in the formulation of a more appropriate and effective treatment plan. 

Dr Vargas said that mild traumatic brain injury (mTBI) or concussion is a common occurrence among people in the United States.

“50‐60 million TBIs are reported per year in the US with 80% being categorized as mTBI and the majority occurring from falls,” he said. “Specific to sports‐related activities, up to 3.8 million sports‐ related mTBIs are reported per year—a number that is felt to be a gross underestimate. Among deployed military personnel, 20% report TBI with >75% being classified as mTBI and 75% being secondary to blast exposure.”

Dr Vargas said that mTBI is a heterogenous disorder. However, he said that post-traumatic headache (PTH) is the most commonly occurring symptom of mTBI and the majority present with features of either migraine or probable migraine. Further, he said that PTH also shares a common pathophysiology with migraine.

“Because the mechanism of injury can vary so widely and because PTH can frequently be multifactorial, a systematic approach to evaluation of TBI is warranted and should include a detailed history, orthostatic blood pressures, and general neurologic, and musculoskeletal exams,” he said.

Dr Vargas stressed that clinical evaluation should dictate the need for specific imagine or diagnostic studies.

“Identifying and addressing the specific and individualized issues and contributory factors that trigger or exacerbate PTH will aid in the formulation of a more appropriate and effective treatment plan leading to better overall outcomes,” he said.

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