Chronic post-traumatic headache: clinical, psychopathological features and outcome determinants

Abstract

The epidemiological and clinical profile of Chronic Post-Traumatic Headache (CPTH) has been studied in 57 out of 130 consecutive patients hospitalized, following closed head injuries, at the Institute of Neurosurgery of the University of Milan. The incidence of CPTH has been 44%. Age of the patients ranged between 4 and 69 years. Clinical pictures included closed head injuries of different degree of severity: mild, moderate and severe. Time of onset, headache frequency, character, intensity, duration and associated symptoms showed a great degree of variability. However, chronic muscle contraction headache was the commonest clinical syndrome followed by migraine. Moderate correlations have been found between the severity of CPTH disturbance of consciousness, following the head trauma, and positive findings at CT scan. Moreover the comparison of personality profiles (MMPI) of CPTH (n=26) with a post-traumatic control group, without headache (n=17) showed higher scores on hypocondriasis, depression, hysteria and schizophrenia scales only in the severe CPTH group. Age of the patients, duration of unconsciousness, neurological deficits, course length and pending litigation or compensations were unrelated to the occurrence and outcome of CPTH. These findings suggest the importance of both physical and psychological determinants (social or emotional maladjustment) in the pathogenesis of CPTH.