Post-traumatic headache phenotypes and clinical characteristics

Area of Science:

• Neurology
• Neuroscience
• Public Health

Background:

• Post-traumatic headache (PTH) shares features with migraine and tension-type headaches but requires distinct characterization.
• Mild traumatic brain injury (mTBI) can lead to persistent headache, impacting quality of life.

Purpose of the Study:

• To characterize the clinical phenotype, headache patterns, associated symptoms, comorbidities, medication use, and functional impact of PTH in adults post-mTBI.
• To identify distinct features of PTH compared to primary headache disorders.

Main Methods:

• Cross-sectional analysis of 405 adult patients with PTH after mTBI.
• Data collected via standardized questionnaires at a specialized concussion and headache center.
• Descriptive statistics used to analyze clinical features, functional impact, and comorbidities.

Main Results:

• Most patients (72.1%) experienced headache ≥26 days/month, often continuous (28.1%) or lasting hours to days (53.1%).
• Headache was typically pulsating/throbbing (64.2%), severe (median 7/10), and associated with photophobia (88.4%), phonophobia (83.2%), and nausea/vomiting (69.0%).
• High rates of psychiatric comorbidities (49.6%), medication overuse (53.8% using acute meds ≥3 days/week), and functional impairment (41.7% off work/school) were observed.

Conclusions:

• PTH exhibits distinct features, including frequent, long-duration headaches, suggesting potential early central sensitization.
• High prevalence of psychiatric comorbidities, medication overuse, and functional impairment necessitates comprehensive management strategies.
• Further research is needed to differentiate PTH from primary migraine longitudinally and understand pathophysiological mechanisms.