Abstract text (incl. figure legends and references)

Background:

Post-traumatic headache, defined as the one that occurs after a traumatic brain injury, can adopt the characteristics of other primary headaches (especially tension-type headache or migraine), and traditionally its management has been that of these headaches. This clinical management lacks solid scientific evidence and is rather based on expert opinions(1).

Materials and methods:

Through the exposure of two cases reports, treatment by anesthetic blocks is suggested as a useful therapeutic tool for these cases.

Results:

The first patient is a 73-year-old woman, who reported that after a mild head injury, she had intermittent headache of varying intensity, oppressive type, of greater intensity at times of greater psychological stress, and of left parieto-occipital location. Normal examination and CT.

Subcutaneous infiltration with bupivacaine is performed in both major suboccipital and supraorbital nerves, and amitriptyline is prescribed. The patient only consumed one container of amitriptyline by mistake, presenting complete resolution of her symptoms since the blockade was performed.

Secondly, we have a 70-year-old man who had a pulsating right hemicranial headache for 30 years, at which time he suffered a trauma in that area. The headache, in the last months had been accentuated. Normal examination and CT.

Amitriptyline was prescribed, and after two months, the patient reported only a slight improvement, proceeding to perform a bupivacaine blockade of both major suboccipital nerves, giving complete resolution of the condition.

Conclusion:

Anesthetic blocks have been positioned as a therapeutic weapon in some types of headaches (migraine, cluster headache, suboccipital neuralgia,...), as we believe that in post-traumatic headache may be.

Ashina H, Eigenbrodt AK, Seifert T, et al. Post-traumatic headache attributed to traumatic brain injury: classification, clinical characteristics, and treatment. Lancet Neurol. 2021 Jun;20(6):460-469.