Position Paper on Post-Traumatic Headache: The Relationship Between Head Trauma, Stress Disorder, and Migraine
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COMMENTARY
Position Paper on Post-Traumatic Headache: The Relationship Between Head Trauma, Stress Disorder, and Migraine Giorgio Lambru
. Silvia Benemei . Anna P. Andreou .
Michelangelo Luciani . Gianluca Serafini . Antoinette Maassen van den Brink . Paolo Martelletti
Received: October 12, 2020 / Accepted: November 16, 2020 Ó The Author(s) 2020
ABSTRACT Traumatic brain injury (mTBI) is a major public health concern, with mild TBI (mTBI) constituting the vast majority of the injuries. Posttraumatic headache (PTH) is one of the most frequent symptoms that follow a mTBI, occurring in isolation with a tension-type or migraine phenotype, or more often as part of a complex neurobehavioural array of symptoms. The existence of PTH as a separate entity from the primary headaches is still a matter of debate. Classification issues and a lack of methodologically robust epidemiological and clinical studies have made it difficult to elucidate the mechanisms underlying acute and even more
G. Lambru (&) A. P. Andreou The Headache Service, Pain Management and Neuromodulation Centre, NHS Foundation Trust, Guy’s and St Thomas, London, UK e-mail: [email protected] S. Benemei Health Sciences Department, Careggi University Hospital, University of Florence, and Headache Centre, Florence, Italy A. P. Andreou Headache Research, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK M. Luciani P. Martelletti Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
persistent PTH (PPTH). Furthermore, psychiatric comorbidities such as post-traumatic stress disorder (PTSD), previous history of migraine, and legal issues often reported by PPTH patients have complicated the understanding of this condition, hence treatment approaches for PTH remain problematic. Recent findings from structural and functional neuroimaging studies have attempted to describe the brain architecture of PPTH, suggesting the involvement of different networks compared to migraine. It also seems that calcitonin gene-related peptide (CGRP) levels are not particularly raised in PPTH, although CGRP monoclonal antibodies have obtained positive initial open-label evidence of efficacy in PPTH, and more trials
M. Luciani P. Martelletti Emergency Medicine Unit, Regional Referral Headache Centre, DAI Medical Sciences, Sant’Andrea Hospital, Rome, Italy G. Serafini Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Childhood Sciences, Psychiatry Unit, University of Genoa, Genoa, Italy G. Serafini IRCCS Ospedale Policlinico San Martino, Genoa, Italy A. M. van den Brink Division of Vascular Medicine and Pharmacology, Erasmus University Medical Center, Rotterdam, The Netherlands
Pain Ther
assessing the efficacy of this class of treatments are underway. The broad overlap between PTH, migraine, and PTSD suggests that research in this field should start with a re-appraisal of the diagnostic criteria, followed by methodologically sound epidemiological and clinical s
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