Observation on analgesic effect of acupuncture combined with manipulation on cervicogenic headache / 中国骨伤

OBJECTIVE@#To compare therapeutic effects between nape acupuncture combined with manipulation and simple manipulation in treating cervicogenic headache, and to verify the synergistic effect of manipulation and nape acupuncture.@*METHODS@#Total 60 patients with cervicogenic headache were divided into two groups:nape acupuncture combined with manipulation group (group A) and manipulation group(group B). There were 30 patients in group A, including 12 males and 18 females with an average age of (41.37±12.09) years old, and an average course of disease of (23.73±15.54) months;there were 30 patients in the manipulation group (group B), including 14 males and 16 females with an average age of (42.40±12.05) years old, and an average course of disease of (25.53±14.33) months. In the group A, acupuncture therapy was performed firstly at the bilateral @*RESULTS@#There was no significant difference in the onset time of analgesia between the two groups[(5.97±3.21) min vs(7.30±3.97) min, @*CONCLUSION@#Nape needling can prolong the analgesic time of manipulation and improve the analgesic effect of manipulation.

Horizontal penetration needling method for headache / 中国针灸

The manipulation and key points of professor

Clinical manifestations and imaging analysis of cervicogenic headache / 中国骨伤

OBJECTIVE@#To investigate the clinical characteristics and mechanism of cervicogenic headache.@*METHODS@#Fifty-seven patients with cervicogenic headache who were treated from May 2013 to December 2017 and had complete imaging data were selected, including 18 males and 39 females with an average age of(43.26±10.39) years old ranging from 20 to 63 years old. The duration of the disease was 4 months to 35 years with a mean of (11.74±9.47) years. The pain situation, iconography and Tinel sign were analyzed.@*RESULTS@#The patients with cervicogenic headache often had bilateral pain. The regions mainly concentrated in the temporal region, with occipital, head or orbit pains. The VAS scores decreased with the duration of the disease. There were many cases of disc herniation(91.30%), vertebral instability(73.91%), atlantoaxial displacement(56.52%), curvature change of cervicogenic vertebra(54.35%). The number of positive Tinel sign points was between 3 and 24 (13.58±5.8) per patient. The number and extent of Tinel sign were significantly different between the affected side and healthy side(<0.05). C₂,₃ facet joints(92.98%), post mastoid(89.47%), occipital concavity(89.47%), C₃,₄ facet joints(84.21%), third occipital nerve(80.70%) were the positive Tinel sign points in patients with cervicogenic headache.@*CONCLUSIONS@#The iconography changes of cervicogenic headache and Tinel sign may contribute to the clinical diagnosis and mechanism of the disease.

Essential Clinical Tips about Ultrasound Guided Cervical Intervention

This report suggests indications, detailed procedures, clinical efficacy and safety of ultrasound (US) guided cervical interventions, such as selective nerve root block (SNRB), medical branch block (MBB), facet joint intra-articular (FJIA) injection, third occipital nerve (TON) block and greater occipital nerve (GON) block. Comparing with fluoroscopy guided transforaminal and interlaminar epidural blocks, US guided cervical interventions have similar clinical effects and superior safety. For cervical axial pain and cervicogenic headache US guided MBB or FJIA injection can be performed. Usual targets of injection are upper cervical (C2–3) for cervicogenic headache and lower cervical (C5–6) for axial neck pain. Clinical effect of US guided MBB is reported to be similar to fluoroscopy guided MBB. Instead of upper cervical (C2–3) facet joint injection, TON block is usually performed. The accuracy of US guided TON block and MBB is reported as high with confirmation of fluoroscopy. GON block can be performed for occipital neuralgia, migraine, chronic daily headache, etc. US guided GON block is much safe and supposed to be highly accurate compared with blind technique. Ultrasonography guided cervical interventions are effective to reduce pain and most of all safe procedure. We need to use ultrasonography guided intervention actively in the field of clinic.

Triple acupuncture method at cervical Jiaji (EX-B 2) for cervicogenic headache: a randomized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To compare the efficacy difference between triple acupuncture method at cervical Jiaji (EX-B 2) and conventional acupuncture for cervicogenic headache.</p><p><b>METHODS</b>A total of 66 patients were randomly divided into a triple acupuncture group and a conventional acupuncture group, 33 cases in each one. The acupoints selected in the two groups were identical, including C1 to C7 of cervical Jiaji (EX-B 2) as well as Baihui (GV 20), Qiangjian (GV 18), Naokong (GB 19), Fengchi (GB 20), Fengfu (GV 16), Tianzhu (BL 10), etc. The conven- tional acupuncture was performed at acupoints on the head in the two groups; triple acupuncture was performed at cervical Jiaji (EX-B 2) in the triple acupuncture group while perpendicular acupuncture was performed with a depth of 25 to 40 mm in the conventional acupuncture group. The treatment was given once a day. Five treatments were considered as one session and totally two sessions were required. The changes of simplified McGill scale before and after acupuncture were observed in the two groups, and the efficacy of the two groups was compared.</p><p><b>RESULTS</b>After acupuncture, the simplified McGill scale was both reduced in the two groups (both P < 0.01), and there was no significant difference between the two groups after treatment (all P > 0.05). The cured and markedly effective rate was 75.8% (25/33) and the total effective rate was 93.9% (31/33) in the triple acupuncture group, which were superior to 57.6% (19/33, P < 0.01) and 84.8% (28/33, P < 0.05) in the conventional acupuncture group respectively.</p><p><b>CONCLUSION</b>The efficacy of triple acupuncture method at cervical Jiaji (EX-B 2) is superior to that of conventional acupuncture for cervicogenic headache.</p>

Study on the clinical effect of the massage method of micro-regulating with vertical cross pressing lying on one side in treating cervicogenic headache / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects of the massage method of micro-regulating with vertical cross pressing lying on one side in treating cervicogenic headache (CEH).</p><p><b>METHODS</b>Total 136 patients with CEH were collected in the study from August 2012 to April 2014. They were divided randomly into two groups according to random digits table. Sixty-nine patients accepted the treatment of micro-regulating with vertical cross pressing lying on one side (pressing micro-regulating group), including 29 males and 40 females with an average age of (50.55 ± 11.38) years old; 67 patients received the treatment of traditional massage (traditional massage group), including 28 males and 39 females with an average age of (51.20 ± 11.90) years old. Clinical effect was observed according to the standard of curative effect of State Administration of Traditional Chinese Medicine; the function of cervical vertebra and all body status were evaluated according to NDI score. VAS score, frequency and time of headache were recorded and compared before and after treatment.</p><p><b>RESULTS</b>No adverse reactions were found after treatment, all patients were followed up from 1 to 6 months with an average of 3.1 months. In pressing micro-regulating group, 25 cases got fully recover, 26 excellence, 14 effectiveness and 4 inefficiency; and in traditional massage group, the results were 12,21,22, 12;clinical effect of pressing micro-regulating group was better than that of traditional massage group (P<0.01). NDI score in pressing micro-regulating group decreased from preoperative 13.48 ± 4.83 to postoperative 6.23 ± 3.76; in traditional massage group also decreased from preoperative 13.82 ± 5.78 to postoperative 8.25 ± 4.75; the improvement of the pressing micro-regulating group was obviously better than that of traditional massage group (P < 0.01). VAS score in pressing micro-regulating group decreased from preoperative 4.75 ± 0.97 to postoperative 1.88 ± 1.78; and in traditional massage group decreased from pre-operative 4.78 ± 0.98 to postoperative 2.84 ± 1.94; pressing micro-regulating group was more notable than that of traditional massage group (P < 0.01). The frequency per week,the pain time in pressing micro-regulating group decreased from preoperative (5.38 ± 1.96) times and (6.87 ± 3.67) hours to postoperative (1.71 ± 2.04) times and (0.97 ± 1.74) hours,respectively,in traditional massage group the above parameters decreased from preoperative (5.22 ± 1.81) times and (6.90 ± 3.79) hours to postoperative (2.81 ± 2.42) times and (1.83 ± 2.21) hours;pressing micr-regulating group was more notable than that of traditional massage group (P < 0.01 or P < 0.05).</p><p><b>CONCLUSION</b>Using the tuina method of micro-regulating with vertical cross pressing lying on one side to treat CEH can improve function of cervical vertebra and all body status, lessen the intensity, frequency, duration time of pain, and had advantage of higher security, simple operation, and evident effect.</p>

Cervicogenic Headache due to Seronegative Rheumatoid Arthritis

No abstract available.

Laws of acupoint selection of prescriptions for treatment of cervicogenic headache by acupuncture: a modern literature research / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To summarize laws of acupoint selection of prescriptions for treatment of cervicogenic headache by acupuncture in modern literature.</p><p><b>METHODS</b>Randomized controlled trials (RCTs) involving acupuncture and moxibustion for treatment of cervicogenic headache were recruited from CBM (1978-2012), VIP (1989-2012), Wanfang Database (1998-2012), CNKI (1979-2012), PubMed (1966-2012), EMbase (1980-2012), and Cochrane Library (Volume 4, 2012). Hand recruitment was also auxiliarily used. The frequency and percentage of common acupoints, the distribution of acupoints along 14 meridians and across each part of the body, the application of specific acupoints, and features of using prescriptions for specific acupoints were statistically described.</p><p><b>RESULTS</b>Totally 37 recruited papers included 42 acupoints and 159 times. Common acupoints covered Fengchi (GB20, 28 times), Jingjiaji (EX-B2, 21 times), Baihui (DU 20, 12 times), Tianzhu (BL9, 1 times), and Ashi point (11 times). Meridians along which acupoints were used mainly covered Foot-shaoyang Gallbladder Meridian, Foot-taiyang Bladder Meridian,and DU meridian. Acupoints were mainly needled from head, neck, and upper limbs. Eight confluence points and luo-connecting point were commonest used as specific acupoints. Acupuncture prescriptions were mostly composed of multiple acupoints. Filliform needle was mainly used in acupuncture methods, followed by electro-acupuncture needle.</p><p><b>CONCLUSIONS</b>Modern acupuncture treatment of cervicogenic headache focuses on local specific points and acupoints along meridians. Acupoints were mostly selected from head, neck, and upper limbs by syndrome typing of Chinese medicine.</p>

Combined third occipital and C3 deep medial branch neurotomy in a patient with C2-3 facet joint osteoarthritis associated cervicogenic headaches: A case report

Cervicogenic headache is pain from the head due to various sources in the cervical spine. The C2-3 zygapophysial joints are the most commonly involved structure, and this type of headache could be relieved by blocks or neurotomy of the third occipital nerve. A 59-years-old female patient suffered from cervicogenic headaches due to severe C2-3 zygapophysial joint hypertrophy. Her pain was partially relieved by the third occipital radiofrequency neurotomy, and was almost completely removed by C3 deep medial branch neurotomy. Herein, we report a case of osteoarthritis associated cervicogenic headaches at the C2-3 zygapophysial joints and proposed a treatment option.

A Case of Neuromyelitis Optica Misdiagnosed as Cervicogenic Headache

Neuromyelitis optica (NMO) is an inflammatory demyelinating disease of the central nervous system associated with longitudinally extensive myelitis and optic neuritis. It is characterized by relapses that lead to blindness and paralysis sequelaes. But, this is rare disease; therefore high clinical suspicion for a correct diagnosis and proper examinations are not easy. However, early diagnosis is essential to prevent sequelae. We report the case of NMO with headache. A 30-year male patient who suffered headache visited our pain clinic because of aggravated pain despite treatment. The cause of the pain was revealed as NMO by more detailed previous history and examination.

Ultrasound-guided Pulsed Radiofrequency of the Third Occipital Nerve

A C2-3 zygapophygeal joint is a major source of cervicogenic headache. Radiofrequency (RF) neurotomy is preformed widely for zygapophygeal joint pain. Conventional RF denervation technique is generally performed under fluoroscopic control. Recently, ultrasound-guided radiofrequency on zygapophygeal joint has emerged as an alternative method. We report our experiences of two successful ultrasound-guided pulsed radiofrequencies on 39-year-old and 42-year-old males, who complained occipital headache and posterior neck pain.

Life quality, depression and anxietysymptoms in chronic post-traumaticheadache after mild brain injury / Qualidade de vida, sintomas de depressão e ansiedade em cefaléia pós-traumática crônica após lesão cerebral leve

ABSTRACT. Post-traumatic headache (PTH) is the most common symptom found in the post-traumatic syndrome, whose onset occurs within seven days of the trauma. The condition is characterized as acute when it persists for up to 3 months. PTH beyond this period is considered chronic. Objectives: The objective of this study was to determine the clinical features of chronic post-traumatic headache (cPTH) and its association with depression, anxiety and quality of life. Methods: A total of 73 female subjects were evaluated. Patients were divided into three groups: (a) group without headache, CONTROL, n=25; (b) cPTH group, n=19; and (c) MIGRAINE, n=29, with all subjects in the 11-84 year age group. Symptoms of anxiety and depression were evaluated by the Beck inventories of anxiety and depression, and quality of life assessed by the Lipp and Rocha quality of life inventory. Qualitative variables were analyzed using the Chi-square or Fisher's exact tests and expressed as percentages whereas quantitative variables were analyzed by ANOVA, Mann-Whitney or Kruskal-Wallis tests with data expressed as mean±standard deviation, p<0.05. Results: Subjects with cPTH presented with headache manifesting similar features to those found in migraine. The cPTH group was associated with similar levels of anxiety and depression to the migraine group and higher than the CONTROL (p<0.001). Quality of life of individuals with cPTH was similar to that of subjects with migraine and lower than CONTROL subjects (p<0.05). Conclusions: cPTH presents similar clinical characteristics to migraine. Subjects with cPTH had high levels of anxiety and depression symptoms and reduced quality of life.

RESUMO. A cefaleia é o sintoma mais encontrado na síndrome pós-traumática, iniciando-se dentro de sete dias após o trauma. Sua a forma aguda dura até três meses e a crônica persiste após este período. Objetivos: O objetivo deste estudo foi determinar as características clínicas da cefaleia pós-traumática crônica (CPTc) e sua associação com a depressão, ansiedade e com nível de qualidade de vida. Métodos: Foram avaliados 73 sujeitos do gênero feminino, divididos em três grupos: (a) grupo sem cefaleia (CONTROLE, n=25), (b) grupo com CPTc (n=19) e (c) migrânea (MIGRÂNEA, n=29), com idades variando entre 11 e 84 anos. Os sintomas de ansiedade e depressão foram avaliados pelos inventários de ansiedade e depressão de Beck e a qualidade de vida pelo inventário de qualidade de vida de Lipp e Rocha. As variáveis qualitativas foram analisadas pelos testes qui-quadrado ou exato de Fisher e expressas em percentuais e as quantitativas por ANOVA, Mann-Whitney ou Kruskal-Wallis com os dados apresentados em média±desvio padrão, p<0,05. Resultados: Os sujeitos com CPTc apresentaram cefaleia com características semelhantes as encontradas na migrânea. A CPTc esteve associada aos níveis de sintomas de ansiedade e depressão similares ao grupo com migrânea e superior ao CONTROLE (p<0,001). Os níveis de qualidade de vida dos sujeitos com CPTc mostraram-se semelhantes aos dos sujeitos com migrânea e inferior ao CONTROLE (p<0,05). Conclusões: A CPTc apresenta características clínicas semelhantes a migrânea. Os sujeitos com CPTc apresentam elevado nível de sintomas de ansiedade e depressão e nível de qualidade de vida reduzida.

Clinical study on acupotomy of occipitalia on the treatment of cervicogenic headache / 中国骨伤

<p><b>OBJECTIVE</b>To observe the effects of acupotomy on cervicogenic headache and explore the function of cutaneous nerve entrapment in the mechanism of cervicogenic headache.</p><p><b>METHODS</b>From October 2008 to June 2009, 82 patients with cervicogenic headache were treated with acupotomy. There were 23 males and 59 females, ranging in age from 17 to 73 years (averaged 41.57 years). The course of disease ranged from 0.5 to 50 years,with an average of 10.4 years. The location of treatment was occipitalia, both of left and right side: altogether were 8 points, including tenderness point of postmastoid; the mid-point between mastoid and C2 spinous process; the internal 1/3 attachment between occipital protuberance and mastoid process; the posterior midline of C2 spinous process open to 1.5-2 cm. The chief complaint of all patients was headache. PPI assessment rating was observed.</p><p><b>RESULTS</b>The total effective rate at 1 month after treatment was 81.70% (67/82). Recurrence of headache within 3 months after treatment was obvious. However, 17.07% (14/82) patients did not reoccur at 6 months after treatment.</p><p><b>CONCLUSION</b>17.07% patients with cervicogenic headache recovered by acupotomy, so it shows cutaneous nerve entrapment plays an important role in the mechanism of cervicogenic headache. For the patients whose headache recurred at 3 months after treatment, increasing the treatment time and therapeutic range is suggested.</p>

Complications of Traumatic Brain Injury: Post-traumatic Headache and Epilepsy

Posttraumatic headache (PTH) is one of several complications of traumatic brain injury (TBI). PTH usually resolving within the first 3 months, although a minority develop chronic headaches. PTH remains among the most controversial headache topics to its propensity for chronicity and often associated additional cognitive, behavioral, and somatic problems. Sufficient psychological or neurobiological markers for PTH do no exist, thus treatment can be very challenging and should always be multidisciplinary to make every reasonable effort in preventing the development of chronic pain. Posttraumatic seizure or epilepsy (PTE) is defined as a recurrent seizure disorder due to traumatic brain injury. PTE can be divided into three groups: immediate, early and late seizures. Immediate and early seizures are provoked seizures, whereas late seizure is unprovoked seizure. The effects of antiepileptic drugs (AED) in patients with TBI must be assessed separately in terms of prevention and control of provoked seizures and prevention of subsequent unprovoked seizures. Routine preventive AEDs are not indicated for patients with TBI and the effects are controversy.

Personality Characteristics of Male Sufferers of Chronic Tension-Type and Cervicogenic Headache

BACKGROUND AND PURPOSE: Chronic tension-type headache (a primary headache disorder) and cervicogenic headache (a secondary headache disorder that is attributable to upper cervical spine pathology) share similar clinical manifestations, but their associated personality traits may differ. We evaluated the personality differences between sufferers of chronic tension-type headache and cervicogenic headache. METHODS: We administered the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ) and the Zuckerman Sensation-Seeking Scale (SSS) to 18 patients suffering from chronic tension-type headache, 19 suffering from cervicogenic headache, and 26 healthy volunteers. Depressive trends were measured with the Plutchik-van-Praag Depression Inventory (PVP). RESULTS: Compared to healthy controls, the chronic tension-type headache group scored significantly higher on ZKPQ Neuroticism-Anxiety and on the PVP, while the cervicogenic headache group scored significantly lower on SSS Thrill and Adventure Seeking. In addition, the total SSS score was significantly lower in the cervicogenic headache group than in both the chronic tension-type headache group and the healthy controls. CONCLUSIONS: The results of this study indicate that higher scores for neuroticism-anxiety and depression were associated with chronic tension-type headache, while lower sensation-seeking scores were associated with cervicogenic headache.

Cefaleia pós-traumática crônica: relato de caso / Post-traumatic chronic headache: case report

JUSTIFICATIVA E OBJETIVOS: De acordo com a Classificação Internacional das Cefaleias, a cefaleia pós-traumática é caracterizada por dor de intensidade variável, máxima na área do trauma, que se inicia em até sete dias após a lesão. O objetivo deste estudo foi relatar o caso de cefaleia pós-traumática crônica, secundária à lesão por arma de fogo. A dor era desencadeada pela palpação de pontos de gatilho em cicatriz.RELATO DO CASO: Paciente do sexo masculino, 31anos, sofreu lesão por arma de fogo na região cervical esquerda,desenvolvendo cefaleia refratária, com área máxima em região de cicatriz. Observou-se ponto de gatilho nessa região. Foi proposto tratamento com bloqueio periférico com excelente resposta.CONCLUSÃO: Sugere-se que a formação de neuromas em áreas de cicatriz possa estar envolvida com a fisiopatologia da cefaleia pós-traumática.

BACKGROUND AND OBJECTIVES: According to the International Classification of Headache Disorders,post-traumatic headache is characterized by pain of variable intensity, maximum in the trauma area, which starts up to seven days after the injury. This study aimed at reporting a case of post-traumatic chronic headache, secondary to firearm injury. Pain was triggered by palpation of triggering points at the scar.CASE REPORT: Male patient, 31 years old, suffered afirearm injury at the left cervical region, developing refractory headache with maximum area at the scar region.Triggering points at the scar region were observed. A treatment with peripheral block was proposed with excellent response.CONCLUSION: It is suggested that the formation of neuromas in scar areas may be involved with the pathophysiology of post-traumatic headache.

effect of methylprednisolone acetate injection at cervical trigger points in both chronic and drug resistant headache

Most adults have surely once experienced a headache. A high percentage of these headaches are the referred pain from cervical structures, such as neck muscles, known as cervicogenic headaches. This study aimed to assess the efficacy of injection of methylprednisolone acetate at the Gallbladder-20 acupuncture points in muscle originated chronic and drug resistant headaches. In this randomized clinical trial study conducted at Shiraz University of Medical Sciences in 2009-2010, 25 patients with both chronic and drug resistant cervicogenic headaches, who had cervical muscle tender points, underwent methylprednisolone acetate injection. To evaluate the severity of these patients' headache, VAS [Visual Analogue Scale] was used. The collected data was analyzed using the SPSS software and Wilcoxon test. The Mean headache intensity on the visual scale of these people before the injection was 3 .2 +/- 76.7. This value was 2.60 +/- 2.9, 3 days after injection. The values at 1 and 3 months post procedure were 3.52 +/- 3.3, and 3.48 +/- 3.5, respectively. In other words, a statistically significant loss of pain score [P<0.001] was observed. The frequency of headache attacks 1 and 3 months after injection decreased 72% and 76% among patients, respectively. Average duration of headache attacks, one month and three months after injection, was decreased in 72 percent of patients. Injection of methylprednisolone acetate at the GB-20acu points in muscle originated cervicogenic headache could be used as an appropriate therapy that has significant therapeutic efficacies only when injected once

The Effect of Radiofrequency Neurotomy of Lower Cervical Medial Branches on Cervicogenic Headache

OBJECTIVE: Cervicogenic headache (CGH) is known to be mainly related with upper cervical problems. In this study, the effect of radiofrequency neurotomy (RFN) for lower cervical (C4-7) medial branches on CGH was evaluated. METHODS: Eleven patients with neck pain and headache, who were treated with lower cervical RFN due to supposed lower cervical zygapophysial joint pain without symptomatic intervertebral disc problem or stenosis, were enrolled in this study. CGH was diagnosed according to the diagnostic criteria of the cervicogenic headache international study group. Visual analogue scale (VAS) score and degree of VAS improvement (VASi) (%) were checked for evaluation of the effect of lower cervical RFN on CGH. RESULTS: The VAS score at 6 months after RFN was 2.7+/-1.3, which were significantly decreased comparing to the VAS score before RFN, 8.1+/-1.1 (p<0.001). The VASi at 6 months after RFN was 63.8+/-17.1%. There was no serious complication. CONCLUSION: Our data suggest that lower cervical disorders can play a role in the genesis of headache in addition to the upper cervical disorders or independently.

Cervicogenic headache arising from hidden metastasis to cervical lymph node adjacent to the superficial cervical plexus: A case report / 대한마취과학회지

The differential diagnosis of headache is often difficult because the symptom of headache is overlapping. Superficial cervical plexus block is useful in diagnosis and treatment of headache. Headache arising from the neck and radiating to the frontotemporal regions and possibly to the supraorbital region has been defined as cervicogenic headache. A positive response to anesthetic blocks is one of the diagnostic criteria of cervicogenic headache. We experienced a case of headache arising from direct lymph node metastasis of hepatocellular carcinoma adjacent to the superficial cervical plexus during treatment of cervicogenic headache under ultrasonographic guidance. Especially in patients with medical history of cancer, practitioners should consider the possibility of metastasis to cervical lymph nodes and using ultrasonography to evaluate the cervical area prior to the practice.

Aspectos clínicos e epidemiológicos da cefaleia pós-traumática crônica / Clinical and epidemiological aspects of chronic post-traumatic headache

Contexto: Existem muitas controvérsias acerca da patogênese da cefaleia pós-traumática, se vem de alterações orgânicas devidas a um trauma cranioencefálico ou se os acometidos dessa condição buscam um ganho secundário. Objetivo: Descrever os aspectos clínicos e epidemiológicos da cefaleia pós-traumática crônica (CPTC) em pacientes atendidos em dois hospitais de referência de Salvador, BA. Métodos: Foram estudados 33 pacientes que preencheram os critérios estabelecidos para CPTC. Resultados: Seis por cento apresentaram frequência de cefaleia inferior a 1 dia por mês; 49%apresentaram frequência de 1 a 7 dias por mês; 30%, de 8 a 14 dias por mês; 6%, por mais de 14 dias por mês, e 9% apresentaram cefaleia diariamente. Quanto à intensidade, 3% dos pacientes classificaram a cefaleia como leve, 30% como moderada e 67% como grave. Vinte e sete por cento caracterizaram sua cefaleia como “em pressão”, 61% como “pulsátil” e 12% como “em pontada”. O diagnóstico da CPTC foi migrânea em 79% dos pacientes e cefaleia tensional em 21% dos pacientes. Conclusão: A maior prevalência de migrânea nesses pacientes se deve ao fato de o trabalho ter sido realizado em um dos centros especializados. A uniformidade do padrão manifestado de cefaleia e a média de idade do aparecimento da cefaleia também falam a favor de uma causa orgânica para a CPTC, entretanto faz-se necessária a realização de estudos experimentais que possam comprovar essa teoria analisando os pacientes mais graves para reforçar a hipótese orgânica para origem da CPTC.

Background: Current data describes 75% to 85% of chronic post-traumatic headaches (CPTH) have a clinical presentation of tension-type headache. Pathogenesis of post-traumatic headache has been controversial; is it an organic secondary lesion due to head trauma or is simulated on aim of a secondary gain. Objective: To describe the clinical and epidemiological aspects of CPTH in two headache centers in Salvador city (Bahia, Brazil). Method: We studied 33 patients that fulfilled the established criteria for CPTH. Results: The frequency of headache was less than 1 day/month in 6% of the patients, 1 to7 days/month in 49%, 8 to 14 days/month in 30%, more than 14 days/month in 6% and 9% had daily headache. Intensity was analyzed and 3% of the patients referred mild headache, 30% moderate and67% referred severe headache. Twenty-seven per cent characterized the headache as “pressing”,61% as “pulsating” and 12% referred the pain manifesting like “sharp “. Migraine type was diagnosed in 79% of the patients and tension-type headache in 21%. Conclusion: A high prevalence of migraine may be explained by the recruitment of more severe patients in specialized centers and it supports the hypothesis of an organic pathogenesis for the CPTH. The uniformity of the pattern of headache and the average age of onset of headache also suggest an organic cause for the CPT, however it is necessary to perform experimental studies that can prove this theory.