Our primary objective was to analyze patients presenting at a tertiary medical center with Post-Traumatic Headaches (PTH) and their medical management.

Post-Traumatic Headaches (PTH) is defined by the International Headache Society as “a headache developing within seven days of the injury or after regaining consciousness”. Headache is the most common symptom after traumatic brain injury (TBI). PTH usually resembles migraine, probable migraine or tension-type headache, but other types of headaches such as cluster headaches can occur. Not only is headache the most common symptom, it can also be the most disabling and persistent.

This observational retrospective database study used the Leaf research database to extract and analyze data in N=4,089 patients diagnosed with PTH (coded as ICD-9 339.20 or ICD-10 G44.309). We recorded patient demographics of this group, and tabulated the frequency of use of different medications, including headache treatments. We also recorded the frequency of comorbidities with PTH including depression, anxiety and insomnia.

In addition to the PTH diagnosis, 31% were categorized as migraine and 21% as tension-type headaches. Opioids were prescribed in nearly half (49.3%) of the PTH patients at least once despite recommendations to the contrary.

Preventive treatments: Topiramate was tried only in 9% of patients even though it is the treatment with the strongest evidence for migraine headache phenotype of PTH.  Onabotulinumtoxin A was prescribed in only 2%.  The majority of PTH patients were seen in the emergency department (43%), while only 26% of patients are being seen by headache specialists. There was a high degree of comorbidity of PTH with depression and anxiety.