Persistent post-traumatic headache attributed to mild traumatic brain injury: Deep phenotyping and treatment patterns

Area of Science:

• Neurology
• Neuroscience
• Headache Medicine

Background:

• Persistent post-traumatic headache (PPTH) is a debilitating condition following mild traumatic brain injury (mTBI).
• Understanding the clinical characteristics and treatment responses in PPTH is crucial for developing effective management strategies.

Purpose of the Study:

• To investigate the clinical characteristics and treatment patterns of persistent post-traumatic headache attributed to mild traumatic brain injury.
• To identify common headache phenotypes and treatment efficacies in this patient population.

Main Methods:

• A cohort of 100 individuals with PPTH attributed to mTBI were enrolled.
• Deep phenotyping utilized semi-structured interviews and the 12-item Allodynia Symptom Checklist.

Main Results:

• The most frequent headache phenotypes were chronic migraine-like (61%) and combined episodic migraine-like/tension-type-like (29%).
• Common triggers included stress, lack of sleep, and bright lights.
• A significant majority (79%) of patients on preventive medication reported treatment failure, with 19% failing at least four drugs.

Conclusions:

• The headache profile in mTBI-related PPTH commonly presents as chronic migraine-like or combined migraine/tension-type.
• Existing migraine-specific preventive medications demonstrated low efficacy.
• There is an urgent need for novel pathophysiological insights and targeted therapies for PPTH.