Interrelations between migraine-like headache and persistent post-traumatic headache attributed to mild traumatic brain injury: a prospective diary study

Håkan Ashina, Afrim Iljazi, Faisal M. Amin, Messoud Ashina, Richard B. Lipton, Henrik W. Schytz

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background: Persistent post-traumatic headache (PTH) is a common sequela of mild traumatic brain injury (TBI) and retrospective assessments have found a migraine-like phenotype to be very frequent. This has raised a discussion of shared underlying mechanisms and whether persistent PTH is simply trauma-triggered migraine. Methods: A 28-day prospective diary study with daily entries and acquisition of data on headache characteristics, associated symptoms, and acute medication use. A total of 64 patients with persistent PTH were enrolled from April 2019 to August 2019. Outcomes were the proportion of monthly headache days of any intensity that met the criteria for a migraine-like day or TTH-like day, as well as the corresponding figures for monthly headache days of moderate to severe intensity. Headache phenotypes were initially assigned based on diagnostic evaluation by semi-structured interview, whilst final headache phenotypes were assigned by diary review. Results: After diary review, we found that monthly headache days were exclusively migraine-like in 24 of 64 patients (38%) and exclusively TTH-like days in 8 of 64 patients (13%). Considering only monthly headache days of moderate to severe intensity, the corresponding figures were 35 of 64 patients (55%) for migraine-like days and 8 of 64 patients (13%) for TTH-like days. The following headache phenotypes were assigned based on diary review: chronic migraine-like (n = 47, 73%), combined episodic migraine-like and chronic TTH-like (n = 9, 13%), and ‘pure’ chronic TTH-like (n = 8, 13%). Conclusions: A migraine-like phenotype is common in patients most adversely affected by persistent PTH, although some patients did have a pure chronic TTH-like phenotype. At minimum, these findings suggest that persistent PTH is – at least in some – not ‘trauma-triggered migraine’.

Original languageEnglish (US)
Article number134
JournalJournal of Headache and Pain
Volume21
Issue number1
DOIs
StatePublished - Dec 2020

Keywords

  • Clinical characteristics
  • Concussion
  • Diagnosis
  • Head trauma

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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