Helmet-Related, External Compression Headache Among Police Officers in Rio de Janeiro

Abouch Krymchantowski, MD, MSc, PhD; Jackeline Soraya Barbosa, MD, MSc; Marcio Cvaigman, MD; Willians Lorenzatto, MD, MSc; Marcus Tulius Silva, MD, MSc

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Summary and Introduction

The International Headache Society has classified the external compression headache as a kind of cranial neuralgia caused by continued external pressure over the head. This headache has peculiar characteristics and resolves after pressure is relieved. The aim of this study was to analyze the occurrence of this headache type among 82 police officers who reported headache after wearing a helmet. We retrospectively studied 82 patients (79 men, 3 women), age 19-35 years (mean, 26), who presented to an outpatient neurology department in a military police hospital with complaints of headache associated with wearing a helmet on at least 3 occasions. The headache subsided after removal of the helmet. During subsequent follow-up consultations, designed to reevaluate the patients and to renew the authorization releasing helmet use, no patients described recurrence of the head pain. We conclude that headache caused by external compression can be related to wearing a helmet, and headache relief can be obtained simply by not wearing such a helmet.

External compression headache is an infrequently cited cranial neuralgia resulting from continued stimulation of the cutaneous nerves caused by the application of pressure over the forehead or scalp. The headache can result from wearing a tight band around the head, a tight hat, or sports goggles, for example. The diagnostic criteria for external compression headache are summarized in the Table 1 .[1] They include a constant nonpulsating head pain felt in the area subjected to pressure that increases over minutes, is not associated with other symptoms, and often disappears within 1 hour after removing the causative stimulus. If the causative stimulus is prolonged, external compression can lead to a more severe, migrainous headache or to a full-blown migraine attack in predisposed patients. This is a primary-type headache, not associated with organic cranial or intracranial disease, and thus does not require further investigation when the diagnostic criteria are fulfilled and the intermittent presentation is clear.[1,2] The goal of this study was to evaluate headache in police officers subsequent to wearing helmets during ordinary patrolling assignments.

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