title: Interdisciplinary treatment of post-concussion and post-traumatic headaches.
abstract: BACKGROUND
  Chronic headaches following concussion are debilitating and difficult to treat. Commonly employed initial therapeutic modalities include pharmacologic, physical, and psychological interventions. Despite these efforts, a subset of patients with chronic pain remains. Peripheral nerve surgery has never before been reported as an effective treatment for the management of post-concussion headaches. In this study, we report on our early outcomes following peripheral nerve surgery for this novel indication.
  
  
  METHODS
  A retrospective review of 28 consecutive patients with post-concussion headaches who underwent occipital nerve surgery was performed. Preoperative and postoperative headache pain was evaluated on visual analog scale (VAS) in 24 patients with at least 6 months follow-up.
  
  
  RESULTS
  The average VAS headache pain reduced from 6.4 preoperatively, to 1.4 (P < 0.0001). Twenty-one patients (88%) had a successful outcome of at least a 50% reduction in their VAS following peripheral nerve surgery. Additionally, twelve patients (50%) were pain free at time of final follow-up. There were no surgical complications.
  
  
  CONCLUSIONS
  Early results indicate peripheral nerve surgery is a safe and effective new therapy for post-concussion headaches in the properly selected patients, whose chronic pain persists despite initial treatments by a neurologist, specialized in headache management. Future studies should focus on larger patient populations, and examine the long-term durability of outcome. In the meantime, an interdisciplinary approach involving neurologists and a peripheral nerve surgeon is suggested for the care of patients with refractory chronic post-concussion occipital neuralgia and other post-traumatic chronic headaches.
authors.affiliation: Plastic Surgery, Nerve and Headache Institute, The George Washington University, McLean, VA.
authors.forename: Ivica
authors.initials: I
authors.lastname: Ducic
authors.affiliation: Department of Plastic Surgery, Georgetown University Hospital, WA, DC.
authors.forename: Jeremy C
authors.initials: JC
authors.lastname: Sinkin
authors.affiliation: Sinai Neurology Associates, Berman Brain and Spine Institute, Sinai Hospital, Baltimore, MD.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Crutchfield
mesh_terms: D000293:Adolescent; D000328:Adult; D001924:Brain Concussion / Q000150:complications*; D002648:Child; D059350:Chronic Pain / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery; D019635:Neurosurgical Procedures / Q000379:methods*; D010147:Pain Measurement; D010525:Peripheral Nerves / Q000601:surgery*; D051298:Post-Traumatic Headache / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D013178:Sports Medicine; D016896:Treatment Outcome; D055815:Young Adult