Steroid-responsive acute post-traumatic headache with neuroinflammation

Post-traumatic headache is a common secondary headache disorder caused by head or neck trauma. However, the etiology and management have not been established. Here, we present a unique case of steroid-responsive acute post-traumatic headache with neuroinflammation following a mild head injury. A 19-year-old female soccer player experienced persistent headache, vomiting, and low-grade fever after sustaining a mild sports-related head injury. Subsequent cerebrospinal fluid (CSF) examination and contrastenhanced magnetic resonance imaging (MRI) revealed leptomeningeal contrast enhancement, elevated intracranial pressure, and an increased CSF cell count. Notably, the patient tested negative for viral, fungal, tumor, and autoimmune markers, thus a diagnosis of acute post-traumatic headache with neuroinflammation was determined. Treatment with dexamethasone (8 mg/day) resulted in rapid symptom relief, enabling the patient to return to sports without symptom recurrence. This case highlights the importance of considering post-traumatic headache with neuroinflammation in patients with atypical post-head injury symptoms. Although her condition shared clinical similarities with concussions, the presence of fever accompanied with specific MRI and CSF findings offered critical diagnostic differentiators. Additionally, our report highlights the potential underdiagnosis of steroid-responsive neuroinflammation following head injury and the necessity for active differential diagnosis.