Traumatic brain injury strategy and action plan (2017–2021)(external link)(external link) ACC, NZ
Traumatic brain injury – diagnosis, acute management and rehabilitation guidelines(external link)(external link) ACC and Ministry of Health, NZ, 2006
Head injury clinical guidelines(external link)(external link) Starship Hospital NZ
Serious illness conversation guide(external link)(external link) Aotearoa Health Quality & Safety Commission, NZ, 2019
Key information about post-traumatic headache provided by Dr Pyari Bose, neurologist, Auckland
Post-traumatic headache (PTH) is the most frequent symptom after mild traumatic brain injury (mTBI). It is estimated that annually 69 million suffer from TBI worldwide, mostly attributable to mTBI. In New Zealand it is estimated that up to 36,000 people suffer TBIs each year, of which 95% are mild.
The leading causes of TBI in New Zealand are falls, mechanical forces, driving-related accidents and assaults. Just over 20% of all TBIs in New Zealand are sustained through sport-related activity.(7)
The underlying cause of PTH is not fully known. It is thought that mechanisms related to both migraine and traumatic brain injury (TBI) are implicated. These include impaired descending pain control networks in the brain, neurochemical changes, neuroinflammation, cortical spreading depression, and release of the pain protein- calcitonin gene-related peptide (CGRP).
The treatment would be determined by evaluation of the underlying headache phenotype. Common patterns of PTH include migraine type and tension type headache patterns. Part of the management also includes addressing if patients are overusing pain medications.
Headaches may resolve within 3 months of the traumatic brain injury but in some patients this may last longer.
Other clinical resources
Stagg K, Douglas J, Iacono T. A scoping review of the working alliance in acquired brain injury rehabilitation(external link) Journal of Disability and Rehabilitation. 2019;41(4):489-497.
Forrest RHJ, Henry JD, McGarry PJ, Marshall RN, Mild traumatic brain injury in New Zealand: factors influencing post-concussion symptom recovery time in a specialised concussion service(external link) Journal of Primary Health Care 10:159-166.
Continuing professional development
Trauma Assessment & Care of the Trauma Patient Webinar - Toni Johnston
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(Mobile Health, NZ, 2020)