Post-traumatic headache
ICD-10 G44.3 · ICD-11 8A84.1

Treatment of Post-traumatic Headache in Post-traumatic Pseudotumor Cerebri

Post-traumatic headache encompasses several distinct phenotypes. One recognised sub-type occurs in the context of post-traumatic pseudotumor cerebri — a presentation that requires a targeted pharmacological approach and carries a specific clinical target for treatment success.

Clinical situation

This protocol applies to patients with post-traumatic headache arising in the setting of post-traumatic pseudotumor cerebri. This phenotype is distinct from more common post-traumatic headache presentations and calls for specific management rather than a general headache algorithm.

Treatment approach (partial overview)

Management in this phenotype centres on a primary oral agent — acetazolamide — as the foundation of treatment. Whether and when a second agent becomes part of the regimen, along with the full prescribing algorithm and monitoring approach, is detailed in the complete protocol.

Treatment goal

The clinical target is resolution of headache without recurrence.

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References

  1. Other phenotypes have also been reported, including a primary stabbing headache that was effectively treated with indomethacin, and post-traumatic pseudotumor cerebri treated with acetazolamide ± topiramate.
  2. Evaluated response to acetazolamide ± topiramate alone for post-traumatic pseudotumor cerebri.
  3. Three of six patients had resolution of HA without recurrence off medication (one required skull surgery in addition to medications); two of three patients treated with acetazolamide and topiramate were unable to wean off acetazolamide and one of three in this group had HA resolution but continued medications.

DOI: 10.1111/head.14795

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