Headache Attributed to Traumatic Brain Injury

Headache can be attributed to a traumatic brain injury if it occurs less than one week after the injury. Headache is seen after insignificant traumas and after mild as well as severe head trauma. The headache disappears in most cases within three months and is then called acute headache attributed to traumatic head injury, but a substantial number of patients continue to have headache after three months and then it is called chronic headache attributed to traumatic head injury. After medication overuse headache, chronic headache attributed to head injury is the most common secondary headache and it causes a big therapeutic problem. It is often associated with other posttraumatic symptoms such as vertigo or dizziness, lack of concentration, fatigue and problems with visual tasks including computer work and watching television. The spontaneous prognosis is good in most cases, since cohorts followed for a prolonged periods of time revealed recovery in more and more patients. There is however a substantial number of patients where the posttraumatic headache continues, and they are especially numerous in specialized headache units. There are no randomized controlled trials of the treatment of this kind of headache and the general impression is, that it is very resistant to pharmacological therapy. At the Danish Headache Center also psychological therapy has proven ineffective as well as physical therapy. There is a tremendous need for more research of this kind of headache, in particularly randomized controlled trials of different aspects of pharmacological treatment or treatment using other modalities such as transcranial electrical stimulation, magnetic stimulations, acupuncture etcetera.