Persistent Post-Traumatic Headache, Postconcussion Syndrome, and Whiplash Injuries: The Evidence for a Non-Traumatic Basis With an Historical Review

Headache: The Journal of Head and Face Pain

Volume 50 Issue 4, Pages 716 - 724

 

CURRENT REVIEW: CLINICAL SCIENCE

Randolph W. Evans, MD

From Baylor College of Medicine, Houston, TX, USA.

Correspondence to  R.W. Evans, 1200 Binz #1370, Houston, TX 77004, USA.

  Conflict of Interest: None

Copyright Copyright © 2010 American Headache Society

ABSTRACT

There has been intense controversy about postconcussion syndrome since Erichsen's publication in 1866 on railway brain and railway spine. The fascinating history of this debate will be reviewed and then the non-organic explanations for postconcussion syndrome, headaches after head injury, and chronic whiplash injuries and headaches will be explored including the following: psychogenic, psychosocial, sociocultural, base rate misattribution, chronic pain, compensation and litigation, and malingering.

 

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.