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. 2020 Nov 19;21(1):134.
doi: 10.1186/s10194-020-01202-6.

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

Håkan Ashina  1 , Afrim Iljazi  1 , Faisal M Amin  1 , Messoud Ashina  1 , Richard B Lipton  2   3 , Henrik W Schytz  4
Affiliations

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

Håkan Ashina et al. J Headache Pain. .

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'.

Keywords: Clinical characteristics; Concussion; Diagnosis; Head trauma.

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Conflict of interest statement

The authors declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: Dr. Faisal M. Amin has received personal fees from Eli Lilly, Novartis, and Teva. Dr. Faisal M. Amin is currently a principal investigator of clinical trials funded by Novartis and Teva. Dr. Faisal M. Amin is an associate editor of Headache Medicine. Dr. Messoud Ashina has received personal fees from Alder BioPharmaceuticals, Allergan, Amgen, Eli Lilly, Novartis, and Teva. Dr. Messoud Ashina has been or is currently a principal investigator of clinical trials funded by Alder BioPharmaceuticals, Amgen, electroCore, Novartis, and Teva. Dr. Messoud Ashina is as an associate editor of Cephalalgia, Headache, and the Journal of Headache and Pain. Dr. Messoud Ashina reports research grants from the Lundbeck Foundation, Novo Nordisk Foundation, and Research Foundation of the Capital Region of Denmark. Dr. Richard B. Lipton is the Edwin S. Lowe Professor of Neurology at the Albert Einstein College of Medicine in New York. He receives research support from the NIH: 2PO1 AG003949 (Multiple Principal Investigator), 5 U10 NS077308 (Principal Investigator), RO1 NS082432 (Investigator), 1RF1 AG057531 (Site Principal Investigator), RF1 AG054548 (Investigator), 1RO1 AG048642 (Investigator), R56 AG057548 (Investigator), K23 NS09610 (Mentor), K23AG049466 (Mentor), and 1K01AG054700 (Mentor). He also receives support from the Migraine Research Foundation and the National Headache Foundation. He serves on the editorial board of Neurology, senior advisor to Headache, and associate editor to Cephalalgia. He has reviewed for the NIA and NINDS; holds stock options in eNeura Therapeutics and Biohaven Holdings; and serves as consultant, advisory board member, or has received honoraria from the American Academy of Neurology, Alder, Allergan, American Headache Society, Amgen, Autonomic Technologies, Avanir, Biohaven, Biovision, Boston Scientific, Dr. Reddy’s, electroCore, Eli Lilly, eNeura Therapeutics, GlaxoSmithKline, Merc k, Pernix, Pfizer, Supernus, Teva, Trigemina, Vector, and Vedanta. He receives royalties from Wolff’s Headache, 7th and 8th Edition, Oxford Press University, 2009, Wiley and Informa. Dr. Henrik W. Schytz has received speaking fees from Novartis, Eli Lilly, and Teva. Dr. Henrik W. Schytz has received a research grant from Novartis. The other authors declare no conflicts of interest.

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