CHARACTERISTICS AND RISK FACTORS OF CHRONIC POST-TRAUMATIC HEADACHE AFTER MILD HEAD INJURY- A STUDY IN A TERTIARY CARE CENTRE IN EASTERN INDIA.

Corresponding Author:
Dr. Shantanu Ghosh,
C/4/49, Kendriya Vihar,
Kolkata-700052, West Bengal, India.
E-mail: shashwata_shantanu@yahoo.co.in

ABSTRACT

BACKGROUND

Traumatic head injury is one of the most important public health problems. 75% of all head injuries are mild. Leading causes of head injuries are road traffic accident, falls, assaults, colliding with moving or stationary objects. Headache is one of the most common symptoms after mild head injuries (MHI). When headache starts within 7 days of head injury, it is called as post traumatic headache (PTH). PTH occurs in 30-90% of patients with MHI, majority of which resolves within a few months, but when it persists beyond 3 months- it is termed as chronic PTH (cPTH). Trauma to the extracranial and intracranial structures produces neurogenic inflammation-leading to both peripheral and central sensitization. They not only produce headache but also help in the perpetuation of pain. Majority of cPTH are tension type headache (TTH) and migraine. Others like medication overuse headache (MOH), coexisting migraine and TTH, cluster headache, occipital neuralgia, hemicrania continua, supraorbital neuralgia are rare. Diagnosis of cPTH is mainly clinical. Investigations are helpful to exclude other secondary causes. Some risk factors like female gender, poor socioeconomic status, past history and family history of headache are associated with cPTH. Aim of the study is to identify the characteristics and risk factors for cPTH in our population.

METHODS

This is a cross sectional observational study that included patients attending outdoor or admitted in the indoor of Neurology and Neurosurgery departments of CNMCH with headache that persisted more than 3 months of MHI. The study period was from 1.8.2016 to 1.7.2018. MHI were diagnosed by emergency and neurosurgery department of our hospitals as those patients who presented within 24 hours with any of the criteria laid down by ICHD3 for MHI. Exclusion criteria were those below 15 years and above 65 years of age, moderate or severe head injury, whiplash injury, MHI with subsequent deterioration, clinical features and imaging suggestive of any other secondary causes of headache. Detailed history was taken, and neurological examination was done to detect the type of headache disorder and exclude other secondary headache disorders. Routine blood tests and CT scan of brain followed by MRI brain were done for every patient while LP and EEG were done in selected cases. In some cases, indomethacin response (Hemicrania continua), nerve block (Occipital, supra orbital neuralgia) was done for confirmation of diagnosis. All data were noted and analysed. This was a cross sectional-observational study and sample size was 91.

RESULTS

Most common types of cPTH were TTH and migraine. Other rare types were occipital neuralgia and supraorbital neuralgia. Chronic TTH is more common than episodic TTH in this sample. Chronic migraine seems to be higher in this patient group compared with non-traumatic migraine. Road traffic accident is still the major cause of head injury. Risk factors for chronic post traumatic headache are female gender, poor literacy rate, higher unemployment rate, poor socioeconomic status and family history of headache.

CONCLUSIONS

Mild head injury may cause a lot of morbidity including various types of headache disorders. Identification of headache disorder is important as the patient can be educated about their illness and proper treatment can be administered, to alleviate their symptoms which can be disabling.