Update on Pharmacology: Pharmacotherapy and Posttraumatic Cephalalgia
Mel B. Glenn MD; (Editor)
Nathan D. Zasler MD, FAAPM&R, FACRM, FAADEP, DAAPM, CBIST

$3.95 		Journal of Head Trauma Rehabilitation
October 2011 
Volume 26  Number 5
Pages 397 - 399
 
  PDF Version Available!

ABSTRACT
THE PHARMACOLOGICAL MANAGEMENT of headache after traumatic brain injury (TBI) and/or general trauma is replete with challenges because of the lack of an adequate body of evidence-based medicine. The general practice trend is to treat these headache disorders as nontraumatic headache disorders would be treated. Surprisingly, there are no Food and Drug Administration (FDA)-approved drug treatments specific to posttraumatic headache, nor for any pediatric headache disorders. This brief review examines current trends in pharmacotherapeutic interventions for the main variants of posttraumatic cephalalgia including migraine, tension headache, neuritic and neuralgic headache, referred myofascial pain headache, and medication overuse headache. The primary focus of this article will be on enteral and topical medications. For more extensive reviews of posttraumatic headache, readers are referred to other, more in-depth, discourses.1,2Patients, as well as significant others/caregivers, need to understand the goals of pharmacotherapy. Education should be provided regarding all relevant aspects of treatment including expected outcomes, potential drug interactions, as well as adverse effects, importance of medication compliance, and adequate trial duration, among other issues. Clinicians should also be familiar with medication-induced headaches as either a cause or a contributor to headache in persons with TBI.There are 3 basic approaches to pharmacotherapeutic management of posttraumatic migraine. These include prophylaxis, abortive therapy, and symptomatic therapy. Migraine prophylactic therapy should be aimed at improving quality of life, decreasing usage of abortive drug therapy as well as reducing complications and attack frequency, severity, and/or duration3,4.Three broad classes of medication are currently endorsed for migraine prophylaxis. These include antiepileptic drugs (AEDs), antihypertensives, and antidepressants. Botulinum toxin A was just recently FDA-approved for

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