Migraine phenotype in post-traumatic headache correlates with worse outcomes
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Children and young adults who experience post-traumatic headache with migraine phenotype may be at increased risk for more significant injury or deleterious pathophysiology after concussion.
Of note, those with post-traumatic headache with a migraine phenotype were more likely to be women, according to the findings published in JAMA Network Open.
“Concussions remain recoverable injuries for most kids who sustain one; however, nearly 20% of kids who have had a concussion will go on to have persistent symptoms beyond 1 month,” Joshua Kamins, MD, assistant clinical professor of neurology at David Geffen School of Medicine at UCLA, told Healio Neurology. “This study was prompted by a 2013 report by the Institute of Medicine that highlighted the knowledge gap concerning youth concussion and recovery. The Four Corners Youth Consortium [4CYC] was created by investigators at UCLA, University of Washington, Children’s National and University of Utah to help bridge this gap. We had existing knowledge that headaches are the most common long-term symptom after concussion and that headaches in the youth population may be different than what we know from adults.”
The study included 281 patients (58.7% girls; 75.6% white; 83.2% aged 13 to 18 years) with 286 concussions included in the 4CYC who presented with a referral of mild traumatic brain injury or concussion within 8 weeks of injury. Researchers used the Post-concussion Symptom Inventory to assess time to recovery and outcomes 3 and 6 months after TBI. They defined a post-traumatic headache as a moderate to severe headache that was new or significantly worse compared with baseline and that correlated with nausea and/or photophobia or phonophobia.
Baseline data showed 46.5% of concussions were accompanied by post-traumatic headache with a migraine phenotype, whereas 20% were accompanied by post-traumatic headache with an on-migraine phenotype and 34% were associated with no post-traumatic headache.
Those with post-traumatic headache with a migraine phenotype were more likely to be female (69.2% vs. 52.6%; P = .03), report depression at baseline (15% vs. 3.8%; P = .04), have a history of migraine (25.2% vs. 2%; P < .001), public health insurance such as Medicaid or Medicare (13.6% vs. 3.5%; P = .02) and a family history of ADHD (21.4% vs. 4.4%; P = .01).
Compared with no post-traumatic headache after concussion, researchers found that patients with headache were more likely to have prolonged recovery (median IQR, 44 days vs. 89 days; log-rank P < .001). In addition, post-traumatic headache correlated with longer recovery times (median IQR, 95 days vs. 70 days; log-rank P = .01).
The researchers noted no significant differences within each phenotype between sexes for recovery or post-traumatic headache at 3 months.
“To me, the most striking takeaway from this study relates to the differences and similarities between boys and girls who sustain a concussion. We have known for some time that a major risk factor for prolonged recovery after concussion is being a girl or woman, but we have never understood why,” Kamins said. “Our study demonstrated that within each group of headache type, there was no difference in recovery between boys and girls; however, because girls are more likely to have migraine and post-traumatic migraine, they are more likely to be in the group with persistent symptoms. This creates a great opportunity for early treatment and to eliminate a major source of gender disparity in concussion recovery.”
Additional research from the 4CYC is ongoing, Kamins added.
“As we gather more data, we will continue to learn about post-traumatic headache and I hope that our future papers will begin to address which medications are the most beneficial,” he said.