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Appendix 1 POSTTRAUMATIC HEADACHE h Arnold P. Friedman, M.D. and H. Mikropolous, M.D. A. INTRODUCTION Chronic headache as a sequela of head injury may follow all types and degrees of head trauma. The incidence of headaches following head in- juries varies in the literature from 28 percent to 65 percent. As emphasized by Denny-Brown (36) and his associate (1), it is evident that the complaints of the patient following head injury will vary not only with the manner and degree of injury but with the personality structure, compensation factors, and the environmental status. The present report is based on a series of 169 patients with posttraumatic headache seen at the Montefiore Hospital as a part of the follow-up study. More than one-half of the patients were of Latin and Semitic extractions, and less than 1 percent (only 1) was Negro. The family histories were not significant in their psychiatric aspects. Only five (3 percent) gave a history of any mental illness. From our inquiries, 146 patients (75 percent) had no neurotic or habit disturbances in infancy or childhood; enuresis and nail biting were reported by 12 patients (7 percent). One hundred and thirty-five patients (80 percent) were in active combat at the time of trauma, and 22 (13 percent) were in a combat area. During the first week following injury, 71 patients (42 percent) had no complaints, 17 (10 percent) were torpid, 9 (5 percent) were confused, and 5 (3 percent) were stuporous. Some 152 patients (90 percent) had fair or good school adjustment. Of this group, 44 (26 percent) were high school graduates, 59 (35 percent) had 1 or 2 years of high school, 20 (12 percent) had 1 or more years of college, and 11 (7 percent) had professional training. In this series it was found that 159 patients (94 percent) were headache- free prior to injury. Of the 10 (6 percent) who had pretraumatic head- aches, 7 (4 percent) were classified as suffering from tension headaches. The onset of headaches was immediate in 25 patients, within 1 week in another 25, and within 1 month following injury in another, a total of 93 men (55 percent). Ten percent of the total group developed headache between 1 and 6 months and 13 percent after the sixth month and up to the fifth year. In the others, the time of onset is unknown. In over 50 percent of the patients (86), the onset of headache was abrupt. 165
136. Watson, C. W.: INCIDENCE OF EPILEPSY FOLLOWING CRANIOCEREBRAL INJURY; THREE-YEAR FOLLOW-UP STUDY, A. M. A. Arch. Neurol. & Psychiat. 68:831-834, 1952. 137. Watts, J. W., Wiley, W. B., and Groh, R. H.: RELATION OF CON- TUSION OF SCALP TO POST-TRAUMATIC HEADACHE AND DIZZINESS, A. Research Nerv. & Ment. Dis. Proc. (1943) 24:562-577, 1945. 138. Williams, D.: ELECTROENCEPHALOGRAM IN CHRONIC POST-TRAUMATIC STATES, J. Neurol. & Psychiat. 4:131-146, 1941. 139. Wilson, D. M.: HEAD INJURIES IN SERVICEMEN OF 1939- 1945 WAR, N. Zealand M. J. 50:383-391, 1951. 164
