Chronic Posttraumatic Headache
Paul N. Duckro John T. Chibnall Saint Louis University
Mild closed head trauma, including acceleration/deceleration injury to the head and neck without direct head strike, is associated with short-term or no loss of consciousness; short-term or no amnesia; and near-normal eye, motor, and verbal responses posttrauma without subsequent deterioration ( Packard & Ham, 1994a). Headache is the most common and intractable complication of mild closed head trauma. Although estimates are variable across studies, the best evidence suggests that 50% to 90% of mild head trauma victims will experience acute headache, 30% to 50% will have headache up to 2 months posttrauma, 20% to 25% will have headache up to 6 months posttrauma, and as many as 10% to 15% will continue to experience significant posttraumatic symptoms, including headache, for 1 year or longer (cf. Alexander, 1995; Alves, Colohan, O'Leary, Rimel, & Jane, 1986; Appenzeller, 1987; Bailey & Gudeman, 1989; Brown, Fann, & Grant, 1994; Jensen & Nielsen, 1990; Moore, 1996; Packard, 1993). With millions of head injuries in the United States each year ( Brown et al., 1994), these percentages represent substantial human and economic costs.
The present chapter is focused on the minority of persons for whom headache becomes chronic (i.e., lasts longer than 6 months) following minor head trauma. Chronic headache does not typically present as a solitary symptom following trauma. Although headache is the most common complication of minor head injury, it is usually one aspect of a syndrome that may include physical (e.g., fatigue, dizziness, tinnitus), psychosocial (e.g., mood swings, depression, irritability, anxiety, anger), and/or cognitive (e.g.,