Headache due to spinothalamic tract injury in patients with mild traumatic brain injury: Two case reports

Medicine, 2019 · DOI: http://dx.doi.org/10.1097/MD.0000000000014306 · Published: February 1, 2019

Simple Explanation

Headache is a common complaint after traumatic brain injury (TBI). This study explores whether damage to a specific nerve pathway in the brain, called the spinothalamic tract (STT), can cause headaches after mild TBI. The researchers used a special brain imaging technique called diffusion tensor tractography (DTT) to examine the STT in two patients who developed headaches after a mild TBI. The results suggested that injury to the STT may indeed be a cause of headaches following mild TBI, and that DTT could be a useful tool for evaluating patients with such headaches.

Study Duration

Not specified

Participants

Two patients with mild TBI

Evidence Level

Level 4: Case Reports

Key Findings

1
DTT scans revealed narrowing of the spinothalamic tract (STT) in both hemispheres of both patients.
2
One patient also showed discontinuations in the STT at the subcortical white matter in both hemispheres.
3
The patients' headaches had characteristics of neuropathic pain and responded well to gabapentin, a medication for nerve pain.

Research Summary

This study reports two cases of patients with mild TBI who developed headaches due to injury of the spinothalamic tract (STT). Diffusion tensor tractography (DTT) revealed narrowing or discontinuation of the STT in these patients, suggesting a link between STT injury and headache. The authors suggest that evaluation of the STT using DTT should be considered in patients with mild TBI who complain of headaches with neuropathic pain characteristics.

Practical Implications

Diagnostic tool

DTT may be a useful tool for identifying STT injuries in patients with post-traumatic headache.

Targeted treatment

Neuropathic pain medications like gabapentin may be effective for headaches caused by STT injury.

Clinical awareness

Clinicians should consider STT injury as a potential cause of headache in patients with mild TBI, particularly when the headache has neuropathic characteristics.

Study Limitations

1
The study is based on only two case reports, limiting generalizability.
2
DTT may underestimate the fibers of the neural tracts in regions of fiber complexity.
3
Further studies with larger numbers of patients are needed to confirm these findings.

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