Post-Traumatic Headache: Is It for Real? Crossfire Debates on Headache: Pro

Headache: The Journal of Head and Face Pain

Volume 50 Issue 4, Pages 710 - 715

Published Online: 13 Apr 2010

CURRENT REVIEW: CLINICAL SCIENCE

Mark Obermann, MD; Matthias Keidel, MD; Hans-Christoph Diener, MD, PhD

From the Department of Neurology, University of Duisburg-Essen, Essen, Germany (M. Obermann and H.-C. Diener); Department of Neurology, Bezirkskrankenhaus Bayreuth, Bayreuth, Germany (M. Keidel).

Correspondence to  H.-C. Diener, Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany.

 Financial support: Dr. Obermann has nothing to declare.

  Conflict of Interest: Dr. Obermann has nothing to declare.

Copyright Copyright © 2010 American Headache Society

ABSTRACT

Mild traumatic brain injury is very common in Western societies, affecting approximately 1.8 million individuals in the USA. Even though between 30% and 90% of patients develop post-traumatic headache, post-traumatic headache remains a very controversial disorder. Particularly when it comes to chronic post-traumatic headache following mild closed head injury and headache attributed to whiplash injury. Some experts are disputing its existence as a genuine disorder. Indistinct disease classification, unresolved pathophysiological mechanism, and the role of accident-related legal issues further fuel this controversy. 

The complex combination of pain and neuropsychological symptoms needs further research in understanding the underlying pathophysiological mechanisms associated with the acute headache following trauma but more so the mechanisms associated with the development of chronic pain in some patients. Investigators should refrain from oversimplifying these complex mechanisms as hysteric exaggeration of everyday complains and from implying greed as motivation for this potentially very disabling disease.

Compensation claim lodgement and health outcome developmental trajectories following whiplash injury: A prospective study

Pain doi:10.1016/j.pain.2010.02.013
Michele Sterlinga, Joan Hendrikzb, Justin Kenardyb
Received 5 August 2009; received in revised form 6 December 2009; accepted 8 February 2010. published online 22 March 2010.
Corrected Proof
Abstract

This study aimed to identify distinctive trajectories for pain/disability and posttraumatic stress disorder (PTSD) symptoms following whiplash injury and to examine the effect of injury compensation claim lodgement on the trajectories. In a prospective study, 155 individuals with whiplash were assessed at <1month, 3, 6 and 12months post injury. Outcomes at each time point were Neck Disability Index (NDI) and the Posttraumatic Stress Diagnostic Scale (PDS). Group-based trajectory analytical techniques were used to identify outcome profiles. The analyses were then repeated after including third party compensation claim lodgment as a binary time-changing covariate. Three distinct NDI trajectories were determined: (1) Mild: mild or negligible pain/disability for the entire 12 months (45%), (2) Moderate: initial moderate pain/disability that decreased to mild levels by 3 months (39%) and (3) Chronic-severe: severe pain/disability persisting at moderate/severe levels for 12 months (16%). Three distinct PTSD trajectories were also identified: (1) Resilient: mild symptoms throughout (40%), (2) Recovering: initial moderate symptoms declining to mild levels by 3months (43%) and (3) Chronic moderate-severe: persistent moderate/severe symptoms throughout 12 months (17%). Claim submission had a detrimental effect on all trajectories (p<0.001) except for the Chronic-severe NDI trajectory (p=0.098). Following whiplash injury, there are distinct pathways of recovery for pain/ disability and PTSD symptoms. Management of whiplash should consider the detrimental association of compensation claim with psychological recovery and recovery of those with mild to moderate pain/disability levels. However, claim lodgement has no significant association with a more severe pain and disability trajectory.