Abstract

MELI, M.G.. A case of post-traumatic headache: Classification, pathophysiology and treatment. Rev. Soc. Esp. Dolor [online]. 2010, vol.17, n.6, pp.274-277. ISSN 1134-8046.

Case report of a 35 year old woman with a post traumatic headache (PTH). Onset of the pain three years earlier, after falling on the ground, which required resuscitation. She had to be on mechanical ventilation for 11 days and suffered several contusions on the right frontal-temporal area of the skull. On discharge, she complained of a continuous bilateral tension headache; she underwent diagnostic cervical medial branch blocks and bilateral mayor occipital nerve blocks with no findings. Subsequently, a C7 stellate ganglion block (SGB) on the right side was performed with full pain relief on the same side. Headache is the most prevalent symptom of post concussion syndrome. Diagnostic criteria for chronic PTH secondary to moderate traumatic brain injury are described in the discussion. The pathophysiology of PTH is poorly understood. Neuroimaging and experimental models offer novel theories to explain a common mechanism for pain in PTH and primary headaches. It is assumed that a central and a peripheral sensitization may act through a common pain pathway such as the cervico-trigeminal relay. After a brain injury, pain pathways may be damaged at different levels, causing different types of pain. A clinical case is described here, in which pharmacotherapy, cervical medial branch blocks and occipital nerve blocks failed. On the other hand, SGB was effective, the reason for which might be found in the pathophysiology of the PTH, as it causes a temporary block of all the sympathetic fibres to the head and neck. If PTH shared the peripheral sensitization mechanism and the vasoregulation impairment with primary headaches, analgesic properties from cervicothoracic sympathetic block would be explained. This unexpected effect should stimulate a review of the International Classification of Headache Disorders II. Stellate ganglion block should be considered as a diagnostic and therapeutic option in case of resistant headache.

Keywords : Post traumatic headache; Stellate ganglion; Cervicothoracic sympathetic block; ICHD II.

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