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 |