Abstract text (incl. figure legends and references)
Post traumatic headache (PTH) is referred to any newly developed or worsened previously existing headache, occurring within 7 days after trauma or regaining consciousness post-trauma. Headaches resolving within 3 months after onset are called acute and persisting beyond 3 months are called persistent.
A prevalence of 33-92% has been reported for PTH. Considering the significant increase in the amount of traumatic injuries, PTH as the most prevalent sequel of trauma is also believed to rapidly increase. Interestingly, there is no dose-response relationship between the injury and headache severity. PTH mostly resembles migraine, tension type, and cervicogenic headaches as well as trigeminal autonomic cephalalgias.
PTH has a benign course with complete symptom resolution. It usually resolves within 3-6 months after its onset, though it might persist for one year or even longer. In a minority of patients headache have a prolong course and sometimes resistant to different treatment modalities.
Risk factors for PTH include age, sex, headache at emergency department at first admission, psychological disorders and medications, substance abuse, history of pre-injury headaches, history of physical or sexual abuse, low educational achievements, medication overuse and associated factors including dizziness, fatigue, decreased concentration, psychomotor slowing, memory problems, insomnia, anxiety, personality changes are addressed for PTH.
Pathophysiology of PTH is mainly related to inflammatory markers increasing in CNS after trauma and increased permeability of blood brain barrier to immune agents and pathogens.
Work up includes comprehensive patient evaluation and tests to rule out serious conditions. Medication usually begins with analgesics and NSAIDs with management of comorbidities and psychological support. If the pain didn"t get resolved, further pharmacologic medication will be prescribed according to the therapeutic management of the nearest headache phenotype.