Post Traumatic Headache: Clinical care of athletes vs non athletes with Persistent Post Traumatic Headache after Concuss
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CONCUSSION AND HEAD INJURY (A FINKEL, SECTION EDITOR)
Post Traumatic Headache: Clinical care of athletes vs non athletes with Persistent Post Traumatic Headache after Concussion: Sports Neurologist and Headache Specialist Perspective F. X. Conidi 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose The purpose of this paper is to review and outline the similarities and differences in the treatment of athletes compared with that of other populations with a persistent post-traumatic headache after a concussion. Recent Findings After an extensive review of the literature and despite well over 2 million Americans experiencing posttraumatic headache (PTH) each year, a number of which will continue to experience persistent post-traumatic headache (PPTH). There is little evidence on the management of the disorder and essentially no evidence-based research when it comes to the management of athletes. Summary With little evidence available for the treatment of individuals with PPTH, be it athletes or non-athletes, the clinician will need to rely on their experience and the application of existing treatments for migraine and chronic migraine. Clearly, more research is needed, especially with respect to the management of athletes versus non-athletes. Keywords Persistent post-traumatic headache . Concussion . Athletes . Management principals
Introduction There are an estimated 2,827,650 emergency room visits for concussions in the USA each year. The actual number of concussions is likely exponentially higher as most patients do not seek treatment [1]. Falls are the most common mechanism [1], with an estimated 4.14 per hundred thousand related to sports [2]. Headache is by far and away the most common symptom related to concussion, with an estimated prevalence of more than 90% [3]. Many of those individuals will go on to develop PPTH. Surprisingly, there is a significant lack of evidence-based studies looking at the treatment of post-traumatic headache [4]. And when it comes to the management of headaches in the concussed athlete, there are essentially no evidenced-based studies (Conidi, poster International Headache Society Annual Meeting, 2011, and This article is part of the Topical Collection on Concussion and Head Injury * F. X. Conidi [email protected] 1
Florida Center for Headache and Sports Neurology, 2525 Burns Road, Palm Beach Gardens, FL 33410, USA
recent unpublished review). A majority of the management is based on consensus opinion, a few case reports, and the clinical experience of the treating physician who will often rely on principals used in the management of non-concussed patients. Given the significant lack of evidence-based studies and even review papers, a number of recommendations in this paper will be based on the authors’ clinical experience in treating PTH.
Definitions For the purpose of this paper, concussion will be defined based on a combination of current guidelines and consensus papers as a prolonged (i.e., > 24 h, < 6 months) transient alteration in neu
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