Legal problems in headache

Problems in expert opinion on headache patients are encountered in particular with cases of so-called posttraumatic headache. Symptoms in the vegetative field due to a head injury are characterized by a close time relationship with the accident or trauma. So is genuine post-traumatic headache. Like the so-called postconcussional syndrome, post-traumatic headache is very vaguely defined. To verify the causal connection between headache and head injury an in-depth neurological analysis is necessary. Lesions of intra- and extra-cranial structures sensitive to pain are apt to bring about subjective complaints in the form of headache. Severe craniocerebral injuries with persisting headache may be suggestive of chronic disturbances in cerebrospinal fluid circulation. On the other hand, extensive compound skull fractures and large cranial trephination defects rarely give rise to headache. Cephalgia occurring after cerebral concussions and minor cerebral contusions subside within a short period of time. The evolution of migraine following a head injury is extremely unusual. However, severe subjective complaints may be caused by traumatic subarachnoidal hemorrhage. An exceptional situation is that of neuralgic pain after an accident with injury to the head, especially in the wake of trigeminal nerve lesions. It seems important to mention the possibility of the combination of organic and psychological factors for cephalgia following craniocerebral trauma. Symptomatic headache generally does not cause special difficulties for expert opinion. However, more problems are encountered in the evaluation and appraisal of persistent headache and other subjective complaints in conversion neurosis and psychogenic disorders. Pensions for headache should only be considered in the most severe cases.