Headache: Posttraumatic Headache.

Posttraumatic headache (PTHA) is defined as headache that develops within 7 days after a head trauma or injury. Reported rates of PTHA range from 30% to 90% among patients who meet criteria for traumatic brain injury. Approximately 20% of PTHAs persist at 1 year after the inciting injury, and nearly 25% of patients report headaches 4 years after the trauma. Confounding variables for prognosis include return to play decisions, injury biomechanics, pain coping resources, medication overuse headache, and mental conditions. Evaluation requires identification of emergent signs or symptoms of postconcussion syndrome. Pre-existing factors, including disordered sleep or mood changes, may delay recovery or alter treatment choices. Pharmacotherapy is based on the primary headache disorder that most resembles the posttraumatic headache of the individual patient. The management strategy should be tailored to patient symptoms, comorbid or pre-existing conditions, and other considerations, including the potential adverse effects of specific drugs.