Successful Treatment with Nerve Decompression Surgery

What is Post–Traumatic Headache

The effect of a head or neck injury can be profound. Headache is the most common complaint and it can occur after mild, moderate or severe head injury. Headache is one of the most common symptoms after traumatic head or brain injury (often called post-traumatic headache). More than 30 percent of people report having headaches that persist long after injury.

Headaches occurring after a history of head and/or neck trauma, such as a car accident or a fall, are classified as post-traumatic headaches. Post-traumatic headaches are considered secondary headaches since they occur as a result of an injury, unlike most migraines, which typically occur without a preceding event.

Post-traumatic headaches are not just restricted to open head wounds or other serious injuries. In fact, one of the difficulties of diagnosis may result from the fact this condition is actually very common in mild head injuries. Of the estimated two million Americans who suffer closed head injuries every year, surveys reveal that a large number of those categorized even “mild” (do not require hospitalization) develop post-traumatic headaches. In an analysis of more than 23 scientific reports of patients who experienced pain after trauma, about 75 percent of the civilian population (non-military) reported headaches after mild traumatic head injury. It is also more common among women, and those with a past history of a headache disorder.

How and When Post-Traumatic Headache Occurs

The onset of headaches is most commonly experienced during the approximate time of injury, and is referred to as an acute post-traumatic headache. If such headaches persist beyond two months, the condition is referred to as chronic post-traumatic headache.

Post-traumatic headaches are usually migraine or tension-type headaches.  Other symptoms may be present. These include dizziness and unsteadiness, poor concentration, sleep disturbance, alterations in personality, and quite commonly anxiety and depression.

Many headache sufferers who have a temporal relationship (a time period between cause and effect) between a traumatic event and onset of the headaches will be diagnosed with both post-traumatic headache and another headache diagnosis, such as: post-traumatic migraine, post-traumatic occipital neuralgia, post-traumatic cervicogenic headache or post-traumatic supraorbital neuralgia.

Post-Traumatic Headache and Inflammation

A blunt trauma to the head and/or neck from something like a whiplash injury (typically a car accident) is likely to cause inflammation in these areas, especially in the posterior neck and occipital regions.  These inflammatory changes are not reliably detected on an MRI.  Nonetheless, there is a characteristic inflammatory response that occurs in the human body after injury that begins with swelling in the muscles and other deeper tissues. Unless rapid resolution occurs, the swelling leads to chronic tissue thickening and hardening, adherence between different structures, and ultimately, a build-up of scar tissue.

One possible effect of this inflammatory process is peripheral nerve compression, a problem that can occur in many parts of the body. This compression affects the peripheral nervous system, which comprises all the nerves that lie outside of the central nervous system. When a peripheral nerve gets too compressed as it passes underneath or through a tight or damaged region, it can result in inflammation.

When an inflammatory process in the head and neck causes peripheral nerve compression, it can result in a chronic, debilitating headache, especially involving the occipital nerves that run up the back of the neck and posterior scalp. Additional areas of involvement include the lower anterior forehead, the temples, and the TMJ (jaw socket) region.

Treatment for Post-Traumatic Headache

Unless there are obvious findings on a cervical or brain MRI, clinicians are unlikely to treat patients with post-traumatic headaches any differently from those with migraines or occipital neuralgia not related to previous head injury. At The Institute for Advanced Reconstruction, however, we view post-traumatic headache as a unique condition, one that warrants its own diagnosis and treatment.

Nerve decompression surgery can be effective at reversing the effects of nerve compression after an inflammatory process. At The Institute for Advanced Reconstruction in New Jersey, Dr. Matthew Kaufman has been performing this procedure since 2007. Our surgical outcomes indicate that of numerous headache patients treated, those with post-traumatic headaches have a high rate of success after nerve decompression surgery relative to other procedures.

A small but significant study verifies our experience with this procedure. In the 2008 study, Posttraumatic Headache: Surgical Management of Supraorbital Neuralgia1, it was determined that nerve decompression surgery appears to be an effective treatment. At The Institute for Advanced Reconstruction, we will highlight similar results from our practice in coming academic and medical forums.

Although it is often difficult to predict how much any individual headache sufferer will benefit from nerve decompression surgery, it is not unusual for patients with post-traumatic headaches to experience total or near-total relief of their chronic headaches almost immediately after surgery.

1http://www.ncbi.nlm.nih.gov/pubmed/18520879



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