Assessment and Management of Post-traumatic Headache.

Abstract

PURPOSE OF REVIEW: The goal of this narrative review is to provide a comprehensive analysis of Post-Traumatic Headache (PTH), addressing its epidemiology, pathophysiology, and multidisciplinary management. The paper seeks to explore the diagnostic controversies surrounding the timing of symptom onset and evaluates current assessment methods and treatment paradigms for this prevalent sequela of traumatic brain injury. RECENT FINDINGS: Recent research highlights that while current diagnostic criteria require headache onset within seven days of injury, delayed-onset symptoms are common, creating a significant diagnostic dilemma. Pathophysiologically, PTH is understood to be multifaceted, driven by neuroinflammation, neurometabolic cascades, and central sensitization. These processes result in clinical phenotypes that often mirror primary migraine or tension-type headaches. Additionally, while clinical history remains the gold standard for assessment, emerging blood biomarkers are showing promise as objective tools for evaluation. The review concludes that PTH management currently requires a multimodal approach, combining non-pharmacological interventions with pharmacological treatments adapted from primary headache protocols. A major takeaway is the lack of high-quality, PTH-specific randomized controlled trials, which currently forces a reliance on expert opinion rather than robust clinical evidence. To improve patient outcomes, future research must shift toward a more multi-disciplinary, patient-centered paradigm and focus on generating high-quality data to move beyond diagnostic controversies and empiric treatment.