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Evans RW. The Postconcussion Syndrome and Posttraumatic Headaches in Civilians, Soldiers, and Athletes. Neurol Clin 2024; 42:341-373. [PMID: 38575256 DOI: 10.1016/j.ncl.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Posttraumatic headaches are one of the most common and controversial secondary headache types. After a mild traumatic brain, an estimated 11% to 82% of people develop a postconcussion syndrome, which has been controversial for more than 160 years. Headache is estimated as present in 30% to 90% of patients after a mild head injury. Most headaches are tension-type-like or migraine-like. Headaches in civilians, soldiers, athletes, and postcraniotomy are reviewed. The treatments are the same as for the primary headaches. Persistent posttraumatic headaches can continue for many years.
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Affiliation(s)
- Randolph W Evans
- Neurology, Baylor College of Medicine, 1200 Binz #1370, Houston, TX 77004, USA.
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Mukhtarzada MG, Monteith TS. Equity and Disparities in Diagnosis, Management, and Research of Post-Traumatic Headache. Curr Pain Headache Rep 2022; 26:555-566. [PMID: 35567660 DOI: 10.1007/s11916-022-01058-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW There are notable health disparities and inequities in individuals with traumatic brain injury (TBI) and concussion by race, ethnicity, gender, socioeconomic status, and geography. This review will evaluate these disparities and inequities and assess the social determinants of health that drive outcomes for post-traumatic headache. Interventions for achieving this are also discussed. RECENT FINDINGS Significant disparities and inequities exist in TBI and concussion among people of different races, socioeconomic status, and geographic locations. Migraine is a common symptom post-concussion, for which disparities and social determinants of health are also discussed. Overall, multi-level interventions to reduce these disparities and inequities are reviewed for post-traumatic headache but require further investigation. Interventions are needed to reduce disparities and inequities including public health initiatives, improvements in clinical care, diversity/inclusion training, and research efforts. As literature expands, we can form guidance to identify solutions for eliminating disparities in care of diverse populations.
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Affiliation(s)
- Mejgan G Mukhtarzada
- Department of Neurology-Headache Division, University of Miami, Miller School of Medicine, 1120 NW 14 Street #13th floor, Miami, FL, 33136, USA
| | - Teshamae S Monteith
- Department of Neurology-Headache Division, University of Miami, Miller School of Medicine, 1120 NW 14 Street #13th floor, Miami, FL, 33136, USA.
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Chowdhary K, Enam N. Post-traumatic Headaches After Traumatic Brain Injury: Current Clinical Approaches. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00314-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Huckhagel T, Westphal M, Klinger R. The Impact of Surgery-Related Muscle Injury on Prevalence and Characteristics of Acute Postcraniotomy Headache - A Prospective Consecutive Case Series. J Neurol Surg A Cent Eur Neurosurg 2021; 83:242-251. [PMID: 34192783 DOI: 10.1055/s-0041-1725958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE The latest third edition of the International Classification of Headache Disorders delineates diagnostic criteria for acute headache attributed to craniotomy (AHAC), but data on possible predisposing factors are sparse. This prospective observational study aims to evaluate the impact of surgery-related muscle incision on the prevalence, severity, and characteristics of AHAC. PATIENTS AND METHODS Sixty-four consecutive adults (mean age: 54.2 ± 15.2 years; 26 males and 38 females) undergoing cranial neurosurgery for various reasons without preoperative headache were included. After regaining consciousness, all patients reported their average daily headache on a numeric pain rating scale (NRS; range: 0-10), headache characteristics, as well as analgesic consumption from day 1 to 3 after surgery. Three distinct patient cohorts were built with respect to the surgical approach (craniotomy ± muscle incision; burr hole surgery) and group comparisons were performed. Additionally, patients with AHAC ≥ 3 NRS were reevaluated at 7.2 ± 2.3 months following treatment by means of standardized questionnaires to determine the prevalence of persistent headache attributed to craniotomy as well as headache-related disability and quality of life. RESULTS Thirty of 64 (46.9%) patients developed moderate to severe AHAC (NRS ≥ 3) after cranial neurosurgery. There were no significant group differences with regard to age, gender, or general health condition (American Society of Anesthesiologists Physical Status Classification). Craniotomy patients with muscle incision suffered from significantly higher early postoperative mean NRS scores compared with their counterparts without procedure-related muscle injury (3.4 ± 2.3 vs. 2.3 ± 1.9) as well as patients undergoing burr hole surgery (1.2 ± 1.4; p = 0.02). Moreover, the consumption of nonopioid analgesics was almost doubled following muscle-transecting surgery as compared with muscle-preserving procedures (p = 0.03). Young patient age (odds ratio/95% confidence interval for each additional year: 0.93/0.88-0.97) and surgery-related muscle injury (5.23/1.62-19.41) were identified as major risk factors for the development of AHAC ≥ 3 NRS. There was a nonsignificant trend toward higher pain chronification rate as well as headache-related disability after craniotomy with muscle injury. CONCLUSION Surgery-related muscle damage may be an important predisposing factor for AHAC. Therefore, if a transmuscular approach is unavoidable, the neurosurgeon should be aware of the need for adequately adjusted intra- and postoperative analgesia in these cases.
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Affiliation(s)
- Torge Huckhagel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Regine Klinger
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Friedman BW, Irizarry E, Cain D, Caradonna A, Minen MT, Solorzano C, Zias E, Zybert D, McGregor M, Bijur PE, Gallagher EJ. Randomized Study of Metoclopramide Plus Diphenhydramine for Acute Posttraumatic Headache. Neurology 2021; 96:e2323-e2331. [PMID: 33762421 DOI: 10.1212/wnl.0000000000011822] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 02/02/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether IV metoclopramide 20 mg + diphenhydramine 25 mg (M + D) was more efficacious than IV placebo for acute moderate or severe posttraumatic headache in the emergency room. METHODS We conducted this randomized, double-blind, placebo-controlled, parallel-group study in 2 urban emergency departments (EDs). Participants who experienced head trauma and presented to our EDs within 10 days with a headache fulfilling criteria for acute posttraumatic headache were included. We randomized participants in a 1:1 ratio to M + D or placebo. Participants, caregivers, and outcome assessors were blinded to assignment. The primary outcome was improvement in pain on a scale of 0 to 10 between baseline and 1 hour after treatment. RESULTS This study was completed between August 2017 and March 2020. We screened 414 patients for participation and randomized 160: 81 to M + D and 79 to placebo. Baseline characteristics were comparable between the groups. All enrolled participants provided primary outcome data. Patients receiving placebo reported mean improvement of 3.8 (SD 2.6), while those receiving M + D improved by 5.2 (SD 2.3), for a difference favoring metoclopramide of 1.4 (95% confidence interval [CI] 0.7-2.2, p < 0.01). Adverse events were reported by 35 of 81 (43%) patients who received metoclopramide and 22 of 79 (28%) of patients who received placebo (95% CI 1-30 for difference of 15%, p = 0.04). CONCLUSION M + D was more efficacious than placebo with regard to relief of posttraumatic headache in the ED. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov Identifier: NCT03220958. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that for patients with acute moderate or severe posttraumatic headache, IV M + D significantly improved pain compared to placebo.
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Affiliation(s)
- Benjamin W Friedman
- From the Department of Emergency Medicine (B.W.F., E.I., D.C., D.Z., M.M., P.E.B., E.J.G.) and Medical College (A.C.), Albert Einstein College of Medicine, Montefiore, Bronx; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York; and Pharmacy Department (C.S., E.Z.), Montefiore, Bronx, NY.
| | - Eddie Irizarry
- From the Department of Emergency Medicine (B.W.F., E.I., D.C., D.Z., M.M., P.E.B., E.J.G.) and Medical College (A.C.), Albert Einstein College of Medicine, Montefiore, Bronx; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York; and Pharmacy Department (C.S., E.Z.), Montefiore, Bronx, NY
| | - Darnell Cain
- From the Department of Emergency Medicine (B.W.F., E.I., D.C., D.Z., M.M., P.E.B., E.J.G.) and Medical College (A.C.), Albert Einstein College of Medicine, Montefiore, Bronx; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York; and Pharmacy Department (C.S., E.Z.), Montefiore, Bronx, NY
| | - Arianna Caradonna
- From the Department of Emergency Medicine (B.W.F., E.I., D.C., D.Z., M.M., P.E.B., E.J.G.) and Medical College (A.C.), Albert Einstein College of Medicine, Montefiore, Bronx; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York; and Pharmacy Department (C.S., E.Z.), Montefiore, Bronx, NY
| | - Mia T Minen
- From the Department of Emergency Medicine (B.W.F., E.I., D.C., D.Z., M.M., P.E.B., E.J.G.) and Medical College (A.C.), Albert Einstein College of Medicine, Montefiore, Bronx; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York; and Pharmacy Department (C.S., E.Z.), Montefiore, Bronx, NY
| | - Clemencia Solorzano
- From the Department of Emergency Medicine (B.W.F., E.I., D.C., D.Z., M.M., P.E.B., E.J.G.) and Medical College (A.C.), Albert Einstein College of Medicine, Montefiore, Bronx; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York; and Pharmacy Department (C.S., E.Z.), Montefiore, Bronx, NY
| | - Eleftheria Zias
- From the Department of Emergency Medicine (B.W.F., E.I., D.C., D.Z., M.M., P.E.B., E.J.G.) and Medical College (A.C.), Albert Einstein College of Medicine, Montefiore, Bronx; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York; and Pharmacy Department (C.S., E.Z.), Montefiore, Bronx, NY
| | - David Zybert
- From the Department of Emergency Medicine (B.W.F., E.I., D.C., D.Z., M.M., P.E.B., E.J.G.) and Medical College (A.C.), Albert Einstein College of Medicine, Montefiore, Bronx; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York; and Pharmacy Department (C.S., E.Z.), Montefiore, Bronx, NY
| | - Michael McGregor
- From the Department of Emergency Medicine (B.W.F., E.I., D.C., D.Z., M.M., P.E.B., E.J.G.) and Medical College (A.C.), Albert Einstein College of Medicine, Montefiore, Bronx; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York; and Pharmacy Department (C.S., E.Z.), Montefiore, Bronx, NY
| | - Polly E Bijur
- From the Department of Emergency Medicine (B.W.F., E.I., D.C., D.Z., M.M., P.E.B., E.J.G.) and Medical College (A.C.), Albert Einstein College of Medicine, Montefiore, Bronx; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York; and Pharmacy Department (C.S., E.Z.), Montefiore, Bronx, NY
| | - E John Gallagher
- From the Department of Emergency Medicine (B.W.F., E.I., D.C., D.Z., M.M., P.E.B., E.J.G.) and Medical College (A.C.), Albert Einstein College of Medicine, Montefiore, Bronx; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York; and Pharmacy Department (C.S., E.Z.), Montefiore, Bronx, NY
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McMurry HS, Tsang DC, Lin N, Symes SN, Dong C, Monteith TS. Head injury and neuropsychiatric sequelae in asylum seekers. Neurology 2020; 95:e2605-e2609. [PMID: 33004606 DOI: 10.1212/wnl.0000000000010929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 07/14/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Asylum seekers experience a high burden of physical and psychological trauma, yet there is a scarcity of literature regarding the epidemiology and sequelae of head injury (HI) in asylum seekers. We examined HI prevalence and association with neuropsychiatric comorbidities in asylum seekers. METHODS A retrospective cross-sectional study was performed through review of 139 medical affidavits from an affidavit database. Affidavits written from 2010 to 2018 were included. Demographic and case-related data were collected and classified based on the presence of HI. For neuropsychiatric sequelae, the primary study outcome was headache and the secondary outcomes were depression, posttraumatic stress disorder, and anxiety. Multivariable logistic regression was performed to examine the association between HI and neuropsychiatric sequelae, adjusted for demographic and clinical characteristics. RESULTS A total of 139 medical affidavits of asylum seekers were included. The mean age was 27.4 ± 12.1 years, 56.8% were female, and 38.8% were <19 years. Almost half (42.5%) explicitly self-reported history of HI. Compared to clients who did not report HI, clients with HI were older and more likely to report a history of headache, physical abuse, physical trauma, concussion, and loss of consciousness. After adjustment for demographic and clinical characteristics, clients with HI had greater odds for neuropsychological sequelae such as headache (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.0-8.7) and depression (OR 2.5, 95% CI 1.1-5.7). CONCLUSIONS We observed a high prevalence of HI in asylum seekers. Comprehensive screening for HI and neuropsychiatric comorbidities is encouraged when evaluating asylum seekers.
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Affiliation(s)
- Hannah S McMurry
- From the Division of Infectious Diseases and Immunology/Allergy (S.N.S.) and Clinical Translational Research Division (C.D.) and Headache Division (T.S.M.), Department of Neurology, University of Miami Miller School of Medicine (H.S.M., D.C.T., N.L., S.N.S., C.D., T.S.M.), FL
| | - Darren C Tsang
- From the Division of Infectious Diseases and Immunology/Allergy (S.N.S.) and Clinical Translational Research Division (C.D.) and Headache Division (T.S.M.), Department of Neurology, University of Miami Miller School of Medicine (H.S.M., D.C.T., N.L., S.N.S., C.D., T.S.M.), FL
| | - Nicole Lin
- From the Division of Infectious Diseases and Immunology/Allergy (S.N.S.) and Clinical Translational Research Division (C.D.) and Headache Division (T.S.M.), Department of Neurology, University of Miami Miller School of Medicine (H.S.M., D.C.T., N.L., S.N.S., C.D., T.S.M.), FL
| | - Stephen N Symes
- From the Division of Infectious Diseases and Immunology/Allergy (S.N.S.) and Clinical Translational Research Division (C.D.) and Headache Division (T.S.M.), Department of Neurology, University of Miami Miller School of Medicine (H.S.M., D.C.T., N.L., S.N.S., C.D., T.S.M.), FL
| | - Chuanhui Dong
- From the Division of Infectious Diseases and Immunology/Allergy (S.N.S.) and Clinical Translational Research Division (C.D.) and Headache Division (T.S.M.), Department of Neurology, University of Miami Miller School of Medicine (H.S.M., D.C.T., N.L., S.N.S., C.D., T.S.M.), FL
| | - Teshamae S Monteith
- From the Division of Infectious Diseases and Immunology/Allergy (S.N.S.) and Clinical Translational Research Division (C.D.) and Headache Division (T.S.M.), Department of Neurology, University of Miami Miller School of Medicine (H.S.M., D.C.T., N.L., S.N.S., C.D., T.S.M.), FL.
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Pohl H, Schubring-Giese M, Gantenbein AR. Can Anything Good Ever Come From Bearing Migraine Attacks? Suggestions for a Comprehensive Concept of Gain in Migraine. Curr Pain Headache Rep 2019; 23:90. [PMID: 31734850 DOI: 10.1007/s11916-019-0829-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarise the current state of knowledge concerning known types of gain, the reasons why patients might seek it, as well as implications for headache disorders. RECENT FINDINGS Even though the subject has been studied in the past, it received less attention in recent years. There is no doubt that migraine is a highly disabling disorder. However, attacks sometimes may be beneficial for the migraine brain as a time-out from the daily routine. On the other hand, patients are often stigmatised as trying to satisfy other needs through their disease. These "other needs" may be the exaggerated seeking for attention and affection or an undue official sickness certificate and were named secondary gain. Striving for secondary gain denotes a behaviour that aims at benefiting from a disease in a way that is seen as inappropriate by others. The fact that the term has persisted in doctors' vocabulary for decades probably indicates that it designates a concept considered relevant by many. However, its usage is complicated by its usually imprecise definition. We found in a literature search that the strive for secondary gain is not limited to neurosis, might both occur consciously and unconsciously, sometimes may aim at financial gain and sometimes at social gain, and can either be potentially expected or readily obtained. This behaviour mainly seems to aim at shaping one's interactions with the environment. Its causes have not been elucidated completely, though, but "unrequited demands for love, attention and affection" have been postulated. The desire for social gain can be influenced by approaches based upon behavioural psychology. Broaching the issue of secondary gain may be beneficial in the daily clinical routine.
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Affiliation(s)
- Heiko Pohl
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.
| | | | - Andreas R Gantenbein
- RehaClinic Bad Zurzach, Bad Zurzach, Switzerland
- University of Zurich, Zurich, Switzerland
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Evans RW, Ghosh K. A Survey of Neurologists on Postconcussion Syndrome. Headache 2018; 58:836-844. [DOI: 10.1111/head.13272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 11/26/2022]
Affiliation(s)
| | - Kamalika Ghosh
- Department of Psychology; Rice University; Houston TX USA
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Makdissi M, Schneider KJ, Feddermann-Demont N, Guskiewicz KM, Hinds S, Leddy JJ, McCrea M, Turner M, Johnston KM. Approach to investigation and treatment of persistent symptoms following sport-related concussion: a systematic review. Br J Sports Med 2017; 51:958-968. [DOI: 10.1136/bjsports-2016-097470] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2017] [Indexed: 11/03/2022]
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Chu J, McNally S, Bruyninckx F, Neuhauser D. American football and other sports injuries may cause migraine/persistent pain decades later and can be treated successfully with electrical twitch-obtaining intramuscular stimulation (ETOIMS). ACTA ACUST UNITED AC 2017; 3:104-114. [PMID: 28890798 PMCID: PMC5468521 DOI: 10.1136/bmjinnov-2016-000151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 12/10/2016] [Accepted: 03/07/2017] [Indexed: 12/03/2022]
Abstract
Introduction Autonomous twitch elicitation at myofascial trigger points from spondylotic radiculopathies-induced denervation supersensitivity can provide favourable pain relief using electrical twitch-obtaining intramuscular stimulation (ETOIMS). Aim To provide objective evidence that ETOIMS is safe and efficacious in migraine and persistent pain management due to decades-old injuries to head and spine from paediatric American football. Methods and materials An 83-year-old mildly hypertensive patient with 25-year history of refractory migraine and persistent pain self-selected to regularly receive fee-for-service ETOIMS 2/week over 20 months. He had 180 sessions of ETOIMS. Pain levels, blood pressure (BP) and heart rate/pulse were recorded before and immediately after each treatment alongside highest level of clinically elicitable twitch forces/session, session duration and intervals between treatments. Twitch force grades recorded were from 1 to 5, grade 5 twitch force being strongest. Results Initially, there was hypersensitivity to electrical stimulation with low stimulus parameters (500 µs pulse-width, 30 mA stimulus intensity, frequency 1.3 Hz). This resolved with gradual stimulus increments as tolerated during successive treatments. By treatment 27, autonomous twitches were noted. Spearman's correlation coefficients showed that pain levels are negatively related to twitch force, number of treatments, treatment session duration and directly related to BP and heart rate/pulse. Treatment numbers and session durations directly influence twitch force. At end of study, headaches and quality of life improved, hypertension resolved and antihypertensive medication had been discontinued. Conclusions Using statistical process control methodology in an individual patient, we showed long-term safety and effectiveness of ETOIMS in simultaneous diagnosis, treatment, prognosis and prevention of migraine and persistent pain in real time obviating necessity for randomised controlled studies.
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Affiliation(s)
- J Chu
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Ardmore, Pennsylvania, USA
| | | | | | - D Neuhauser
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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Fraser F, Matsuzawa Y, Lee YSC, Minen M. Behavioral Treatments for Post-Traumatic Headache. Curr Pain Headache Rep 2017; 21:22. [PMID: 28283812 DOI: 10.1007/s11916-017-0624-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Post-traumatic headache (PTH) is a common headache type after traumatic brain injury (TBI). There are no FDA approved medications for PTH, and it is unknown how medications can affect the brain's ability to recover from TBI. Thus, we sought to examine the biopsychosocial factors that influence PTH and the non-pharmacologic treatments studied for headache treatment. We also sought to determine if there is literature examining whether the non-pharmacologic treatments influence the biopsychosocial factors. The non-pharmacologic treatments assessed included cognitive behavioral therapy (CBT), biofeedback, progressive muscle relaxation therapy (PMR), acupuncture, and physical therapy (PT). RECENT FINDINGS Factors associated with prognosis in PTH may include the following: severity of TBI, stress, post-traumatic stress disorder, other psychiatric comorbidities, sociocultural and psychosocial factors, litigation, base rate misattribution, expectation as etiology, and chronic pain. There are few high quality studies on the non-pharmacologic treatments for PTH. Thermal and EMG biofeedback appear to have been examined the most followed by CBT. Studies did not have secondary outcomes examining the psychosocial factors related to PTH. Most of the behavioral studies involved a multi-modality intervention limiting the ability to assess the individual non-pharmacologic interventions we sought to study. There were very few randomized clinical trials evaluating the efficacy of non-pharmacologic interventions. Therefore, future research, which considers the noted biopsychosocial factors, is needed in the field to determine if these interventions reduce PTH.
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Affiliation(s)
- Felicia Fraser
- Rusk Rehabilitation, NYU Langone Medical Center, New York City, USA
| | - Yuka Matsuzawa
- Rusk Rehabilitation, NYU Langone Medical Center, New York City, USA
| | | | - Mia Minen
- Department of Neurology, NYU Langone Medical Center, 240 East 38th Street 20th floor, NY, NY, 10016, USA.
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Abstract
BACKGROUND Chronic headache following traumatic brain injury (TBI) sustained in military service, while common, is highly challenging to treat with existing pharmacologic and non-pharmacologic interventions and may be complicated by co-morbid posttraumatic stress. Recently, a novel form of brainwave-based intervention known as the Flexyx Neurotherapy System (FNS) that involves minute pulses of electromagnetic energy stimulation of brainwave activity has been suggested as a means to address symptoms of TBI. This study reports on a clinical series of patients with chronic headache following service-connected TBI treated with FNS. METHODS Nine veterans of the wars in Afghanistan and Iraq with moderate to severe chronic headaches following service-connected TBI and complicated by posttraumatic stress symptoms were treated in 20 individual FNS sessions at the Brain Wellness and Biofeedback Center of Washington (in Bethesda, Maryland, USA). They periodically completed measures including the Brief Pain Inventory-Headache (BPI-HA) past week worst and average pain ratings, the Posttraumatic Stress Disorder Checklist-Military version (PCL-M), and individual treatment session numerical rating scale (NRS) for degree of cognitive dysfunction. Data analyses included beginning to end of treatment t-test comparisons for the BPI-HA, PCL-M, and cognitive dysfunction NRS. RESULTS All beginning to end of treatment t-test comparisons for the BPI-HA, PCL-M, and cognitive dysfunction NRS indicated statistically significant decreases. All but one participant experienced reduction in headaches along with reductions in posttraumatic stress and perceived cognitive dysfunction, with a subset experiencing virtual elimination of headaches. One participant obtained modest headache relief but no improvement in posttraumatic stress or cognitive dysfunction. CONCLUSIONS FNS may be a potentially efficacious treatment for chronic posttraumatic headache sustained in military service. Further research is needed to investigate the efficacy of FNS within a randomized, controlled clinical trial, to identify characteristics of those most likely to respond, and to explore underlying mechanisms that may contribute to improvement.
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Taylor FR, Landy SH, Kaniecki RG. Abstracts and Citations. Headache 2014. [DOI: 10.1111/head.12424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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