Table 1 Comparison of the characteristics between persistent PTH and primary headaches
From: Persistent post-traumatic headache: a migrainous loop or not? The clinical evidence
Persistent PTH | Migraine | Tension-type headache | Cluster headache | |
|---|---|---|---|---|
Prevalence | 18–58% after TBI | 6–33% | 62% | 0.1% |
Risk factors | -Prior history of headache -Female gender - Older age - Family history of headache | -Young age -Female gender | -Anxiety -Depression | -Young age -Male gender |
Duration of episodes | Variable | 180 min-3 days | 30 min-7 days | 15–180 min |
Headache symptoms | -Migraine-like -Tension-type headache like -Cluster like | -Severe intensity -Unilateral location -Pulsatile quality -Aggravated by activity | -Mild/moderate intensity -Bilateral location -Pressing quality -Not aggravated by activity | -Severe intensity -Unilateral, orbital or periorbital |
Associated symptoms | -Sleep disorders -Affective and behavioral disorders -Cognitive deficits | -Nausea or vomiting -Photophobia and phonophobia | -Photophobia, phonophobia or nausea | -Conjunctival injection, nasal congestion, eyelid edema, miosis, ptosis. -Sense of restlessness or agitation |
Imaging (MRI) | -Less cortical thickness in bilateral frontal regions and right hemisphere parietal regions of the brain -Gray matter changes in the prefrontal cortex. | -White matter hyperintensities | -Normal | -Normal |
Neurophysiological studies (EEG) | Early abnormalities (focal slowing, absence of activity, amplitude asymmetries) | -H response to flicker stimulation -Abnormal resting-state EEG rhythmic activity | Normal | Normal |
Treatment | -Behavioral -Drugs depending on phenotype | -Acute: NAIDs / triptans -Preventive: β-blockers, antiepileptics, antihypertensive, CGRP Abs | -Acute: NAIDs -Preventive: antidepressants | -Acute: triptans/O2 -Preventive: corticosteroids, verapamil |