摘要:

Posttraumatic headache (PTHA) although quite common, is still poorly understood in many ways. This article will provide opinions, insights, and analysis of some of the ongoing controversies and issues in PTHA assessment and treatment. Topics germane to nomenclature problems, classification criteria, paradoxes regarding headache incidence relative to injury severity, lack of identified medical specialty for referral of patients with PTHA, medicolegal issues, PTHA perpetuating factors, impairment and disability assessment, and research needs are addressed. Recommendations for addressing some of the concerns brought up in this commentary will be focused on in the article's concluding comments. These caveats and controversies will hopefully serve to familiarize readers with some of the inherent difficulties in PTHA management and treatment.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

This article presents an overview of the epidemiology and pathophysiology of posttraumatic headache. It reviews definitions of mild head injury (MHI), mild traumatic brain injury (MTBI), and concussion, and discusses the confusion that often occurs with these terms. Headache types and their pathophysiology are examined in detail. Just as the exact pathophysiology is unknown for migraine and other types of headache, the exact pathophysiology of headache after trauma is also still unknown in many cases. Possible connections between head or neck injuries and headache are reviewed, as well as hypothesized neurochemical changes that may occur in both migraine and traumatic brain injury (TBI). Psychological and legal factors are also considered.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The evaluation of the person with posttraumatic headache remains a difficult clinical task. The rehabilitation clinician seeing the person with posttraumatic headache may encounter a large spectrum of potential etiologies for cephalgia. We believe an ordered approach to the history, physical, and laboratory examination may lead to a more accurate and focused diagnosis in some cases. In an attempt to provide a directed approach to posttraumatic headaches, this discussion is divided into extracranial and intracranial sources. A brief table guide to the etiology of pain by site is presented, and the key eight steps of examination are reviewed.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Posttraumatic headache can be a very difficult syndrome to manage, especially if chronic. As with most other types of headache, medications are the primary treatment modality, although there is very limited evidence based data to support any given approach. A number of physical interventions also are available to be used in conjunction with medication, particularly for headaches with a musculoskeletal component. This article will review the general principles of pharmacological treatment for headache and the physical approach to treatment of headaches and head and facial pain. The major categories of medications commonly used for treatment of many varieties of headache will be discussed. In addition, the problems encountered in diagnosing and treating chronic daily headache and analgesic rebound headache are addressed. The approach to treatment of such syndromes as myofascial pain, cervicozygapophyseal joint pain, neuritic pain, and craniocervical somatic pain are outlined.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Posttraumatic headache (PTHA) is a frequent occurrence following trauma to the head, brain, and/or neck. Estimates of persistence for 6 months are as high as 44%. Review of available studies examining the effect of headache on neuropsychological test findings reveals that chronic headache pain, and chronic pain generally, exerts a significant and negative effect that poses a challenge to differential diagnostic efforts in the evaluation of mild brain injury. Given that PTHA is the most common postconcussive symptom and most frequent type of posttraumatic pain associated with mild traumatic brain injury (TBI), it follows that resolution of the postconcussion syndrome, and successful posttraumatic adaptation, may frequently rely on success in coping with PTHA symptomatology. Viewing PTHA from a biopsychosocial perspective, a general outline is offered for improving both assessment and treatment of PTHA. In addition, the most promising psychology-based treatment interventions are reviewed.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

This study addresses (1) the relationship between headache presence/intensity at time of testing and neurocognitive performance, and (2) the probability that testing triggers or intensifies pain. Subjects were 125 patients with chronic posttraumatic headache (mean = 2.67 years post injury) who completed a 4-hour test battery emphasizing memory. Comparisons of 34 individual tests/subtests and the five Wechsler Memory Scale—Revised (WMS-R) indices of relative memory impairment for 73 patients with no headache or mild headache versus 52 patients with moderate to severe pain revealed no significant differences. Testing intensified existing headaches for 55% but triggered headache for only 1 of 20 (5%;P= .00003). Results support the validity of neuropsychological test performance regardless of pain level, although testing can be painful.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

This case presentation will review tension pneumocephalus as a rare etiology of delayed posttraumatic headache (PTHA). It demonstrates that clinicians must be aware of even the uncommon causes of PTHA if appropriate diagnostic assessment and treatment are to be rendered. The case involves a 26-year-old right-handed white male who was 4 years post severe traumatic brain injury with facial fractures and an initial Glasgow Coma Scale score of 5. The patient's main postinjury functional impairments were cognitive–behavioral dysfunction, dysmetria, left hemiparesis, and posttraumatic epilepsy. Approximately 3 years post injury, the patient started to have complaints of right unilateral frontal headache. This complaint was addressed conservatively by several treating physicians. Due to the progressive nature of the patient's complaints, a second opinion was obtained with the author. On assessment, the patient complained of unilateral right headache and described the pain as making him feel as if his head was going to “bust open.” A computed tomography (CT) scan showed findings consistent with a tension pneumocephalus. The patient was referred to neurosurgery, at which time the tension pneumocephalus was evacuated and a dural leak, felt to be responsible for the condition, patched. The patient's headache complaints resolved postoperatively. Clinicians should be aware of uncommon conditions that may be present in patients presenting with late PTHA, particularly conditions such as tension pneumocephalus which may have a significant clinical morbidity.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective:The objective of this study was to investigate the interrater reliability of the Agitated Behavior Scale.Design:Ratings made by research assistants and nursing staff were compared.Participants and setting:Forty-five persons with brain injury and 23 persons with progressive dementia were studied at an acute rehabilitation unit and a long-term-care facility.Results:Ratings of persons with brain injury by research assistants yielded a correlation coefficient for the Total score of .920. The correlation coefficients for the factors Disinhibition, Aggression, and Lability were .902, .909, and .726, respectively. Lower coefficients were obtained when the ratings of the research assistants and nursing staff were correlated; these ranged from .364 to .604. The ratings by research assistants of long-term-care facility residents yielded coefficients ranging from .860 to .906 for the Total and factor scores.Conclusion:This study shows that the Agitated Behavior Scale is a reliable instrument for measuring agitation in persons with traumatic brain injury, as well as with long-term-care facility residents experiencing dementia.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID