In the IHS
Classification, Section 5.0 is for headache associated with head or neck
trauma. This is further subdivided into 5.1: acute post-traumatic headache, and
5.2: chronic post-traumatic headache. Post‑traumatic headaches are a regular
feature of the post‑traumatic or post concussion syndrome which follows
significant head injury. The syndrome is not necessarily associated with
definable central nervous system injury and can occur whether or not
unconsciousness occurred at the time of trauma.14 The syndrome is
characterized by headache, vertigo, impairment of memory and concentration, and
variable degrees of emotional impairment. Headache lasting more than two months
occurs in up to 60 percent of patients hospitalized following head injury.229
The degree of apparent disability may seem to outweigh the amount of objective
evidence of central nervous system or musculoskeletal injury. Some believe that
persistent symptoms relate to the patient's desire to seek compensation, but
most believe that this occurs only in a small percent. There is evidence that an
organic mechanism is operative in a large proportion of these patients.14,230
The headache
in post‑concussional states usually occurs within a day of the injury but may be
delayed for weeks. It is characterized by a dull, aching, generalized
discomfort with localized exacerbation in bifrontal, bioccipital or bitemporal
locations which may last for hours. The headache tends to be on a daily basis,
but may be periodic and throbbing, quite characteristic of migraine. The usual
course is one of gradual improvement in all symptoms when there is not severe
organic impairment, but the headache may persist for many months.
Both common
and classic migraine may have a significant exacerbation following closed head
injury; uncommonly typical migraine attacks may follow injury in a previously
headache free individual. The incidence of post‑traumatic migraine is higher in
people with a strong family history of migraine headache.
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