Post-Traumatic Headache — SCE Neurology MCQ

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EasyHeadache & Facial PainPost-Traumatic HeadacheSCE Neurology

A 35-year-old rugby player presents with a persistent headache for 6 weeks following a concussion during a match. The headache is daily, bilateral, pressing, with mild photophobia. CT head is normal. He has no red flag features. What is the most likely diagnosis?

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Correct answer: B — Post-traumatic headache

Post-traumatic headache (PTH) is defined by ICHD-3 as headache developing within 7 days of head trauma (or regaining consciousness after trauma). It can persist for >3 months (persistent PTH). The headache phenotype is often tension-type or migraine-like. Management includes reassurance, graded return to activity, avoidance of analgesic overuse, and standard headache preventive treatment if persistent. Red flags (worsening headache, focal neurology, cognitive deterioration) should prompt further imaging. A: The temporal relationship to concussion confirms PTH. B: CT is normal — no subdural haematoma. C: Chronic migraine requires pre-existing migraine history. D: The post-traumatic context makes PTH the primary diagnosis. E: No evidence of analgesic overuse.

Reference: ICHD-3 (2018); Sport Concussion Consensus Statement (2023)