Posttraumatic headache (PTHA) although quite common, is still poorly understood in many ways. This article will provide opinions, insights, and analysis of some of the ongoing controversies and issues in PTHA assessment and treatment. Topics germane to nomenclature problems, classification criteria, paradoxes regarding headache incidence relative to injury severity, lack of identified medical specialty for referral of patients with PTHA, medicolegal issues, PTHA perpetuating factors, impairment and disability assessment, and research needs are addressed. Recommendations for addressing some of the concerns brought up in this commentary will be focused on in the article's concluding comments. These caveats and controversies will hopefully serve to familiarize readers with some of the inherent difficulties in PTHA management and treatment.