PAIN RESEARCH:When the head gets out of balance

Scientists search for possible causes of posttraumatic headache

Posttraumatic headache (PTH) is the most common complication after a traumatic brain injury (TBI). In a review paper, a research team of the Department of Neurology at BG University Hospital Bergmannsheil of Ruhr-Universität Bochum has now consolidated the current state of knowledge about somatosensory dysfunction in patients with PTH. In particular, they succeeded in further discussing the impact of a pain hypersensitivity of the central nervous system as well as the role of pain modulatory systems for the development mechanism of posttraumatic headache. However, final conclusions were limited due to the few data available. The results were published in the renowned journal “Cephalalgia” on 18 August 2021 under the leadership of Professor Elena Enax-Krumova, holder of the endowed professorship of the German Social Accident Insurance (DGUV).

Headache impacts quality of life to a large extent

When headaches occur for the first time and in close temporal relation to a traumatic brain injury with affection of structures relevant to the pain processing, they are classified as “posttraumatic headaches”.

They are different from other types of headache, often affect young patients of working age, for example after occupational or traffic accidents, and can significantly impact their quality of life. Patients sometimes describe the pain as similar to migraine or tension-type headache and also often report anxiety and depressive symptoms as well as cognitive dysfunction.

The treatment options for posttraumatic headache are currently limited due to the poor research situation. Therefore, medications for primary headache disorders are mostly used for posttraumatic headache, although they are not very effective in these cases.

Julia Jessen

The lead author is currently conducting her doctoral thesis on this topic in the Department of Neurology, BG University Hospital Bergmannsheil, within the framework of the Collaborative Research Centre 874 (RUB).

For their review, the neuroscientists from Bochum searched the PubMed database specifically for studies on the topics of “pain modulation” and “quantitative sensory testing” among people with “posttraumatic headache after traumatic brain injury”.

Improved understanding for pathophysiology of chronic pain

The evaluation of the research team showed that the patients exhibited heterogeneous changes in sensory profiles (especially in the pain perception of heat and pressure stimuli) as well as a reduced endogenous pain inhibition.

The overview obtained improves the understanding about the pathophysiology of chronic pain after traumatic brain injury and represents an important step forward to develop target-based personalized treatment.

Prof. Dr. Elena Enax-Krumova

The researchers pointed out that the review has several limitations, most importantly the small number of articles found on the topic. Therefore, it was not possible to identify a definite sensory pattern for patients with posttraumatic headache. However, a disturbed endogenous pain inhibition seems to play a role, although it remains unclear whether this results from the chronic pain state itself or must be considered as a risk factor for its development.

„Further research using longitudinal designs is needed to determine the changes more precisely and put them in a context with other pathophysiological changes to be able to draw conclusions for optimized target-based treatment options”, Julia Jessen describes the conclusion of the work. Only through this it will be possible to further clarify the underlying mechanisms and biomarkers for predicting the development and persistence of pain.

Prof. Dr. Elena Enax-Krumova
Department of Neurology
BG University Hospital Bergmannsheil gGmbH
Bürkle-de-la-Camp-Platz 1, 44789 Bochum
Tel: +49 – (0)234 – 302 – 3402
Fax: +49 – (0)234 – 302 – 6888