Post-traumatic headache two to four months after mild traumatic brain injury: A description of phenotypes and...

AimTo describe headache phenotypes and treatment patterns in adults with moderate to severe post-traumatic headache and a high burden of other post-concussion symptoms two to four months after mild traumatic brain injury.MethodsA cross-sectional study was conducted using patient-reported questionnaire data from 218 individuals, aged 18-60 years, with moderate to severe post-traumatic headache, a headache duration between two and four months, and a high burden of other post-concussion symptoms. The study was based on data from a cohort study with a nested randomized controlled trial called Get Going After Concussion 2.0. Individuals were recruited from emergency departments and general practitioners in Central Denmark Region (1.4 million inhabitants). Phenotyping was performed using an algorithm linking the questionnaire data to diagnostic criteria of primary headache disorders.ResultsAmong the 218 individuals, 62% had acute- and 38% had persistent post-traumatic headache. A migraine-like or probable migraine-like phenotype was identified in 88% of the individuals with no significant differences in phenotype distribution between the acute- and persistent headache subgroups (p = 0.414) or between sexes (p = 0.994). Headache frequency of ≥15 days per month was reported by 78% and average headache intensity was moderate or severe in 94% of all individuals. A pressing and/or tightening headache quality was the most frequent (85%). No significant differences were found between the acute- and persistent headache subgroups regarding pharmacological treatment use or efficacy (p = 0.776). Non-opioid analgesics had been used by 88% of all individuals and 81% were still using them; 52% reported lack of efficacy. Triptans had been or were currently used by 4% of all individuals. Preventive medication, used by 7% of the study population, was reported to have lack of efficacy but all continued treatment. Probable medication overuse headache was found in 27% of the individuals. Overall, 33% had tried two or more non-pharmacological treatments, and 6% had tried between four and six.ConclusionA migraine-like phenotype was the most common presentation in adults with moderate to severe post-traumatic headache and a high symptom burden of other post-concussion symptoms two to four months after trauma. Overall, limited effect of both pharmacological and non-pharmacological treatment was reported. Preventive medication and triptans were used by very few individuals, despite being recommended in current treatment guidelines. The study population exhibited a high health care-seeking behavior, and a large proportion had probable medication overuse headache. Consequently, further insights into disease-specific treatment approaches of post-traumatic headache is needed.