Chapter 25.Posttraumatic Headache

Although posttraumatic headache (PTHA) has historically been considered as a singular headache disorder following brain/head trauma, a more modern view of this problem suggests that PTHA is not a specific diagnosis but is, instead, a posttraumatic symptom produced by one or more causes that must be identified to treat it effectively. Current evidence supports the concept that PTHA is multifactorial in etiology, with different potential headache generators, and where pain perception, adaptation, and duration are affected by an array of biopsychosocial factors, including genetics, culture, potential secondary gain incentives, preinjury resilience and coping, and timeliness of diagnosis-specific pain management interventions, among other factors. It is not, as previously espoused and as still endorsed by many, a unitary headache disorder. The acute, subacute, and chronic forms of PTHA have not been adequately studied as far as etiology, incidence, prevalence, evaluation, treatment, or prognosis. The effect that genetic-loading risk factors; preexisting neck pain and/or headache; anatomic variables, including male/female differences; culture; affective disorders; and/or characterological traits, including resilience, have on influencing incidence, severity, and duration of PTHA have not been delineated well to date. The literature, however, suggests that such variables are potentially relevant in affecting outcomes.