Systematic Review of Interventions for Post Traumatic Headache

CITATION: Watanabe TK, Bell KR, Walker WC, Schomer K. (2011). Systematic Review of Interventions for Post Traumatic HeadachePhysical Medicine and Rehabilitation. (accepted).

OBJECTIVE: Headache is one of the most common physical symptoms after traumatic brain injury. The specific goals of this review include: (1) determination of effective interventions for post-traumatic headache (PTHA), (2) development of treatment recommendations, (3) identification of gaps in the current literature regarding PTHA treatment, and (4) suggestions for future directions in research to improve outcome for persons with PTHA.

DATA SOURCES: Peer reviewed studies in PubMed, CINAHL, PsycINFO, ProQuest, Web of Science, and Google Scholar: (1) including adult and child samples with mild, moderate, or severe TBI, whiplash, and post-concussion syndrome (2) with clearly described interventions (3) with headache treatment as a primary or secondary outcome (4) published since 1985 and (5) written in English.

STUDY SELECTION: Abstracts from 812 articles from the above search were reviewed. All research types that studied the treatment of headache after TBI were included, and 64 of the 812 articles appeared to meet the inclusion criteria.

DATA EXTRACTION: The 64 articles were reviewed in full and data was extracted, 36 met all criteria for inclusion. The final 36 articles were rated according to the American Academy of Neurology criteria for classifying therapeutic studies.

DATA SYNTHESIS: No class I studies and only 1 Class II study for the management of PTHA were identified. One Class I and 1 Class II study for whiplash associated disorder with headache as an outcome were identified. 12 studies met criteria for Class III.

CONCLUSIONS: There is no strong evidence from clinical trials to direct the treatment of PTHA. The authors offer some guidelines for PTHA management based on primary headache categories and treatments. It is essential that well-designed clinical studies be conducted to inform clinicians on management and prevention of PTHA chronicity.