Chronic post-traumatic headache often a myth?

Chronic daily headaches following trauma to the head or neck are a common occurrence. [1-3] The duration of these headaches is unrelated to the severity or type of trauma. [4,5] Neurologists, neurosurgeons, and other physicians often are asked to testify regarding the cause, prognosis, and permanent impairment of the patient with headaches. [5,6] Since many physicians are unaware of the frequency of headache caused by analgesic rebound, [7,8] we suspect that the diagnosis of post-traumatic headache is often made when the actual cause was daily, or almost daily, use of analgesics or opiates. In addition to misleading the judicial system, this leads to an erroneous therapeutic approach. The following case history is presented as an example: A 41-year-old right-handed man was referred to The Vanderbilt Headache Clinic with a 15-year history of headache following an injury. He was passenger in a car that overturned. The driver had been drinking and sustained a neck fracture, but survived without neurologic residual. Another passenger in the car was pronounced dead at the scene. When this patient arrived at the local emergency room, he was unconscious with a blood pressure of 54/38 mm Hg. The left pupil was dilated and left abducens palsy was noted. Deep pain stimulation on the left side of the body produced movement of the left arm, leg, and face. There was no movement of the right side of the face or extremities. Responses to painful stimuli on the right were decreased compared with those on the left, suggesting a partial sensory loss on that side. No abnormal reflexes were obtained. There was evidence of trauma to the right periorbital region, the mouth, the anterior chest, and the right arm and leg. Heart, lungs, and abdomen were normal. The admission hematocrit was 39.5% …