An updated brief overview on post-traumatic headache and a systematic review of the non-pharmacological interventions for its management

ABSTRACT

Introduction

Post-traumatic headache (PTH), a common type of headache secondary to traumatic brain injury (TBI) or whiplash, carries a relevant burden on patients. PTH is still an undertreated condition because of limited pharmacological treatment options. Therefore, multimodal non-pharmacologic approaches, which account for comorbidities and biopsychosocial factors, are often used in PTH patients.

Areas covered

After providing a brief overview of PTH, a systematic review was conducted, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations on recently published (2015–2020) papers on non-pharmacological interventions for PTH. We also collected data on ongoing trials on this topic. Studies and results are reviewed and discussed.

Expert opinion

PTH is one of the most common complications of TBI and accounts for almost 4% of symptomatic headache disorders. The most common clinical presentations of PTH are migraine-like or tension type (TTH)-like headache, neck pain, cognitive complaints, and psychological/psychiatric symptoms. Growing evidence suggests that combined pharmacological and non-pharmacological interventions, encompassing noninvasive neuromodulation, physical therapy, cognitive-behavioral treatment, and education, may be the best approaches for PTH and related comorbidities. Acute/preemptive pharmacological treatments for PTH include drugs used for migraine and TTH. When PTH management is multidisciplinary, the patient benefits most.

KEYWORDS:

• Post-traumatic headache
• traumatic brain injury
• post-concussion syndrome
• non-pharmacological interventions
• noninvasive brain stimulation
• acupuncture
• therapeutic exercise
• biofeedback
• cognitive-behavioral therapy

Article highlights

• Post-traumatic headache (PTH) ranks among the most common headache disorders and is secondary to traumatic brain injury

• There are significant unmet needs with PTH pharmacological therapies that are unspecific and hampered by side-effects

• The evidence on pharmacological and non-pharmacological treatments for PTH is still preliminary

• Non-invasive brain stimulation and cognitive-behavioral therapy are the non-pharmacological strategies with more robust evidence

• A multimodal approach encompassing non-pharmacologic strategies and accounting for comorbidities and biopsychosocial factors should be considered in patients with PTH

• Multidisciplinary interventions may be more effective for PTH compared to single modality approaches

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.