Skip to main content Accessibility help
×
Home

Narrative Review of the Pathophysiology of Headaches and Photosensitivity in Mild Traumatic Brain Injury and Concussion

  • Christopher Mares (a1), Jehane H. Dagher (a1) (a2) and Mona Harissi-Dagher (a3)

Abstract

The most common symptom of post-concussive syndrome (PCS) is post-traumatic headache (PTH) accompanied by photophobia. Post-traumatic headache is currently categorized as a secondary headache disorder with a clinical phenotype described by its main features and resembling one of the primary headache disorders: tension, migraine, migraine-like cluster. Although PTH is often treated with medication used for primary headache disorders, the underlying mechanism for PTH has yet to be elucidated. The goal of this narrative literature review is to determine the current level of knowledge of these PTHs and photophobia in mild traumatic brain injury (mTBI) in order to guide further research and attempt to discover the underlying mechanism to both symptoms. The ultimate purpose is to better understand the pathophysiology of these symptoms in order to provide better and more targeted care to afflicted patients. A review of the literature was conducted using the databases CINAHL, EMBASE, PubMed. All papers were screened for sections on pathophysiology of PTH or photophobia in mTBI patients. Our paper summarizes current hypotheses. Although the exact pathophysiology of PTH and photophobia in mTBI remains to be determined, we highlight several interesting findings and avenues for future research, including central and peripheral explanations for PTH, neuroinflammation, cortical spreading depolarization and the role of glutamate excitotoxicity. We discuss the possible neuroanatomical pathways for photophobia and hypothesize a possible common pathophysiological basis between PTH and photophobia.

Revue non systématique de la pathophysiologie des céphalées et de la photosensibilité dans le cas de traumatismes crânio-cérébraux légers. Les symptômes les plus courants du syndrome post-commotionnel (SPC) sont des céphalées post-traumatiques (CPT) accompagnées de photophobie. Ce type de céphalée est à l’heure actuelle considéré comme un trouble de nature secondaire dont le phénotype clinique et les caractéristiques ressemblent à ceux des céphalées dites primaires: tensions, migraines, maux de tête qui ressemblent à des migraines, algies vasculaires du visage, etc. Bien que les CPT soient souvent traitées par une médication utilisée dans le cas des céphalées dites primaires, il nous reste encore à élucider le mécanisme sous-jacent des CPT. L’objectif de cette revue non-systématique est de déterminer, chez des patients victimes de traumatismes crânio-cérébraux (TCC) légers, l’état actuel des connaissances concernant ce type de maux de tête et la photophobie qui y est associée, et ce, afin d’orienter les recherches ultérieures et de pouvoir découvrir les mécanismes qui président à l’apparition de ces deux symptômes. L’objectif ultime qui est le nôtre est de mieux comprendre la pathophysiologie de ces symptômes en vue de pouvoir offrir aux patients qui en sont atteints des soins mieux ciblés et de meilleure qualité. Nous avons ainsi mené une revue de la littérature au moyen des bases de données suivantes: CINAHL, Embase et PubMed. Tous les articles ont été passés au peigne fin en vue d’identifier, dans le cas de patients victimes de TCC légers, des passages portant sur la pathophysiologie des CPT ou sur la photophobie. Notre article entend aussi résumer les hypothèses actuelles qui portent sur cette question. Quoique la pathophysiologie précise des CPT et de la photophobie associée aux TCC légers restent à déterminer, nous avons mis en lumière plusieurs pistes et constats intéressants en vue d’activités de recherche futures, ce qui inclut des facteurs explicatifs d’origine centrale et périphérique, de la neuro-inflammation, des ondes lentes de dépolarisation (OLD) et le rôle de l’excitotoxicité du glutamate. Nous avons aussi abordé les possibles voies neuro-anatomiques de la photophobie en plus d’émettre l’hypothèse qu’il existe une pathophysiologie commune entre les CPT et la photophobie.

Copyright

Corresponding author

Correspondence to: Jehane H. Dagher, BSc PT, FRCPC, FABPMR, Physical Medicine and Rehabilitation Service, McGill University Health Centre, Montreal General Hospital, Room L7510, 1650 Cedar Avenue, Montreal, Quebec, Canada H3G 1A4. Email: DrDagher@hotmail.com

References

Hide All
1. Conidi, FX. Sports-related concussion: the role of the headache specialist. Headache. 2012;52(Suppl 1):15-21.
2. Vargas, BB, Dodick, DW. Posttraumatic headache. Curr Opin Neurol. 2012;25(3):284-289.
3. Pinchefsky, E, Dubrovsky, AS, Friedman, D, Shevell, M. Part I—Evaluation of pediatric post-traumatic headaches. Pediatr Neurol. 2015;52(3):263-269.
4. McCrory, P, Meeuwisse, W, Dvorak, J, et al. Consensus statement on concussion in sport—the 5th International Conference on Concussion in Sport held in Berlin, October 2016. Br J Sports Med. 2017;51:838-847.
5. Delic, J, Alhilali, LM, Hughes, MA, Gumus, S, Fakhran, S. White matter injuries in mild traumatic brain injury and posttraumatic migraines: diffusion entropy analysis. Radiology. 2016;279(3):859-866.
6. Maroon, JC, LePere, DB, Blaylock, RL, Bost, JW. Postconcussion syndrome: a review of pathophysiology and potential nonpharmacological approaches to treatment. Phys Sports Med. 2013;40(4):73-87.
7. Ghodadra, A, Alhilali, L, Fakhran, S. Principal component analysis of diffusion tensor images to determine white matter injury patterns underlying postconcussive headache. Am J Neuroradiol. 2016;37(2):274-278.
8. D’Onofrio, F, Russo, A, Conte, F, Casucci, G, Tessitore, A, Tedeschi, G. Post-traumatic headaches: an epidemiological overview. Neurol Sci. 2014;35(1):203-206.
9. Kjeldgaard, D, Forchhammer, H, Teasdale, T, Jensen, RH. Chronic post-traumatic headache after mild head injury: a descriptive study. Cephalalgia. 2014;34(3):191-200.
10. Monteith, TS, Borsook, D. Insights and advances in post-traumatic headache: research considerations. Curr Neurol Neurosci Rep. 2014;14(2):428.
11. Blume, HK. Headaches after concussion in pediatrics: a review. Curr Pain Headache Rep. 2015;19(9):42.
12. Erickson, JC, Neely, ET, Theeler, BJ. Posttraumatic headache. Continuum (Minneap Minn). 2010;16(6 Traumatic Brain Injury):55-78.
13. Seifert, T. Post-traumatic headache therapy in the athlete. Curr Pain Headache Rep. 2016;20(6):41.
14. Defrin, R, Gruener, H, Schreiber, S, Pick, CG. Quantitative somatosensory testing of subjects with chronic post-traumatic headache: implications on its mechanisms. Eur J Pain. 2010;14(9):924-931.
15. Defrin, R, Riabinin, M, Feingold, Y, Schreiber, S, Pick, CG. Deficient pain modulatory systems in patients with mild traumatic brain and chronic post-traumatic headache: implications for its mechanism. J Neurotrauma. 2015;32(1):28-37.
16. Mayer, CL, Huber, BR, Peskind, E. Traumatic brain injury, neuroinflammation, and post-traumatic headaches. Headache. 2013;53(9):1523-1530.
17. Sarmento, E, Moreira, P, Brito, C, Souza, J, Jevoux, C, Bigal, M. Proton spectroscopy in patients with post-traumatic headache attributed to mild head injury. Headache. 2009;49(9):1345-1352.
18. Heyer, GL, Idris, SA. Does analgesic overuse contribute to chronic post-traumatic headaches in adolescent concussion patients? Pediatr Neurol. 2014;50(5):464-468.
19. Daiutolo, BV, Tyburski, A, Clark, SW, Elliott, MB. Trigeminal pain molecules, allodynia, and photosensitivity are pharmacologically and genetically modulated in a model of traumatic brain injury. J Neurotrauma. 2016;33(8):748-760.
20. Benromano, T, Defrin, R, Ahn, AH, Zhao, J, Pick, CG, Levy, D. Mild closed head injury promotes a selective trigeminal hypernociception: implications for the acute emergence of post-traumatic headache. Eur J Pain. 2015;19(5):621-628.
21. Marcus, JC, Altura, BT, Altura, BM. Serum ionized magnesium in post-traumatic headaches. J Pediatr. 2001;139(3):459-462.
22. Obermann, M, Keidel, M, Diener, HC. Post-traumatic headache: is it for real? Crossfire debates on headache: pro. Headache. 2010;50(4):710-715.
23. Solomon, S. Chronic post-traumatic neck and head pain. Headache. 2005;45(1):53-67.
24. Riechers, RG 2nd, Walker, MF, Ruff, RL. Post-traumatic headaches. Handb Clin Neurol. 2015;128:567-578.
25. Cutrer, M. Pathophysiology, clinical manifestations, and diagnosis of migraine in adults. In: Dashe J, editor. UpToDate, 2017. Retrieved July 11, 2017 from: https://www.uptodate.com/contents/pathophysiology-clinical-manifestations-and-diagnosis-of-migraine-in-adults?source=search_result&search=migraine%20headache&selectedTitle=2~150
26. Garza, I. Chronic migraine. In: Dashe J, editor. UpToDate, 2018. Retrieved July 7, 2018 from https://www.uptodate.com/contents/chronic-migraine
27. Taylor, F. Tension-type headache in adults: Pathophysiology, clinical features, and diagnosis. In J. Dashe editor. Uptodate, 2016. Retrieved July 11, 2017 from https://www.uptodate.com/contents/tension-type-headache-in-adults-pathophysiology-clinical-features-and-diagnosis?source=search_result&search=tension%20headache&selectedTitle=2~94
28. Lane, J, Arciniegas, D. Post-traumatic headache. Curr Treat Options Neurol. 2002;4:89-104.
29. Bryan, CJ, Hernandez, AM. Predictors of post-traumatic headache severity among deployed military personnel. Headache. 2011;51(6):945-953.
30. Lainez, MJ, Piera, A, Bono, G. Headache attributed to head or neck trauma. Handb Clin Neurol. 2010;97:501-516.
31. Elliott, MB, Oshinsky, ML, Amenta, PS, Awe, OO, Jallo, JI. Nociceptive neuropeptide increases and periorbital allodynia in a model of traumatic brain injury. Headache. 2012;52(6):966-984.
32. Newberg, AB, Serruya, M, Gepty, A, et al. Clinical comparison of 99mTc exametazime and 123I Ioflupane SPECT in patients with chronic mild traumatic brain injury. PLoS One. 2014;9(1):e87009.
33. Levy, D, Edut, S, Baraz-Goldstein, R, et al. Responses of dural mast cells in concussive and blast models of mild traumatic brain injury in mice: potential implications for post-traumatic headache. Cephalalgia. 2016;36(10):915-923.
34. Su, SH, Xu, W, Li, M, et al. Elevated C-reactive protein levels may be a predictor of persistent unfavourable symptoms in patients with mild traumatic brain injury: a preliminary study. Brain Behav Immun. 2014;38:111-117.
35. Torrente, D, Cabezas, R, Avila, MF, Garcia-Segura, LM, Barreto, GE, Guedes, RCA. Cortical spreading depression in traumatic brain injuries: is there a role for astrocytes? Neurosci Lett. 2014;565:2-6.
36. Kramer, DR, Fujii, T, Ohiorhenuan, I, Liu, CY. Cortical spreading depolarization: pathophysiology, implications, and future directions. J Clin Neurosci. 2016;24:22-27.
37. Seifert, T, Shipman, V. The pathophysiology of sports concussion. Curr Pain Headache Rep. 2015;19(8):36.
38. Packard, RHL. Pathogenesis of posttraumatic headache and migraine: a common headache pathway? Headache. 1997;37:142-152.
39. Goryunova, AV, Bazarnaya, NA, Sorokina, EG, et al. Glutamate receptor autoantibody concentrations in children with chronic post-traumatic headache. Neurosci Behav Physiol. 2007;37(8):761-764; http://dx.doi.org/10.1007/s11055-007-0079-3
40. Digre, KB, Brennan, KC. Shedding light on photophobia. J Neuro-Ophthalmol. 2012;32(1):68-81.
41. Katz, BJ, Digre, KB. Diagnosis, pathophysiology, and treatment of photophobia. Surv Ophthalmol. 2016;61(4):466-477.
42. Truong, JQ, Ciuffreda, KJ, Han, MHE, Suchoff, IB. Photosensitivity in mild traumatic brain injury (mTBI): a retrospective analysis. Brain Inj. 2014;28(10):1283-1287.
43. Clark, J, Hasselfeld, K, Bigsby, K, Divine, J. Colored glasses to mitigate photophobia symptoms posttraumatic brain injury. J Athl Train. 2017;52(8):725-729.
44. Mansur, A, Hauer, TM, Hussain, MW, et al. A nonliquid crystal display screen computer for treatment of photosensitivity and computer screen intolerance in post-concussion syndrome. J Neurotrauma. 2018;35(16):1886-1894.
45. Bulson, R, Jun, W, Hayes, J. Visual symptomatology and referral patterns for operation Iraqi freedom and operation enduring freedom veterans with traumatic brain injury. J Rehab Res Dev. 2012;49(7):1075-1082.
46. Goodrich, GL, Flyg, HM, Kirby, JE, Chang, CY, Martinsen, GL. Mechanisms of TBI and visual consequences in military and veteran populations. Optom Vis Sci. 2013;90(2):105-112.
47. Blumenfeld, H. Neuroanatomy through clinical cases. Sunderland Massachusetts: Sinauer Associates; 2010.
48. Du, T, Ciuffreda, KJ, Kapoor, N. Elevated dark adaptation thresholds in traumatic brain injury. Brain Inj. 2005;19(13):1125-1138.
49. Magone, MT, Kwon, E, Shin, SY. Chronic visual dysfunction after blast-induced mild traumatic brain injury. J Rehab Res Dev. 2014;51(1):71-80.
50. Goodrich, GL, Martinsen, GL, Flyg, HM, Kirby, J, Garvert, DW, Tyler, CW. Visual function, traumatic brain injury, and posttraumatic stress disorder. J Rehab Res Dev. 2014;51(4):547-558.
51. Defrin, R. Chronic post-traumatic headache: Clinical findings and possible mechanisms. J Man Manip Ther. 2014;22(1):36-43.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed