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. 2021 Mar 1;4(3):e211312.
doi: 10.1001/jamanetworkopen.2021.1312.

Evaluation of Posttraumatic Headache Phenotype and Recovery Time After Youth Concussion

Joshua Kamins  1   2 , Rachel Richards  3 , Bradley J Barney  3 , Christopher Locandro  3 , Christina F Pacchia  3 , Andrew C Charles  1 , Lawrence J Cook  3 , Gerard Gioia  4 , Christopher C Giza  2   5 , Heidi K Blume  6
Affiliations

Evaluation of Posttraumatic Headache Phenotype and Recovery Time After Youth Concussion

Joshua Kamins et al. JAMA Netw Open. .

Abstract

Importance: The Four Corners Youth Consortium was created to fill the gap in our understanding of youth concussion. This study is the first analysis of posttraumatic headache (PTH) phenotype and prognosis in this cohort of concussed youth.

Objective: To describe the characteristics of youth with PTH and determine whether the PTH phenotype is associated with outcome.

Design, setting, and participants: This cohort study examined outcomes from patients in a multi-institutional registry of traumatic brain injury (TBI) clinics from December 2017 to June 2019. Inclusion criteria included being between ages 5 and 18 years at enrollment and presentation within 8 weeks of a mild TBI. Data were analyzed between February 2019 and January 2021.

Exposure: Mild TBI with standard care.

Main outcomes and measures: Time to recovery and headache 3 months after injury; measurement device is the Postconcussion Symptom Inventory (PCSI). PTH with migraine phenotype was defined as moderate-severe headache that is new or significantly worse compared with baseline and associated with nausea and/or photophobia and phonophobia.

Results: A total of 612 patients with 625 concussions were enrolled, of whom 387 patients with 395 concussions consented to participate in this study. One hundred nine concussions were excluded (concussions, rather than patients, were the unit of analysis), leaving 281 participants with 286 concussions (168 [58.7%] girls; 195 [75.6%] White; 238 [83.2%] aged 13-18 years). At the initial visit, 133 concussions (46.5%) were from patients experiencing PTH with a migraine phenotype, 57 (20%) were from patients experiencing PTH with a nonmigraine phenotype, and 96 (34%) were from patients with no PTH. Patients with any PTH after concussion were more likely to have prolonged recovery than those without PTH (median [interquartile range], 89 [48-165] days vs 44 [26-96] days; log-rank P < .001). Patients with PTH and a migraine phenotype took significantly longer to recover than those with nonmigraine phenotype (median [interquartile range], 95 [54-195] days vs 70 [46-119] days; log-rank P = .01). Within each phenotype, there was no significant difference between sexes in recovery or PTH at 3 months.

Conclusions and relevance: PTH with a migraine phenotype is associated with persistent symptoms following concussion compared with nonmigraine PTH or no PTH. Given that female sex is associated with higher rates of migraine and migraine PTH, our finding may be one explanation for findings in prior studies that girls are at higher risk for persistent postconcussion symptoms than boys.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Kamins reported receiving consulting fees from Lundbeck. Dr Charles reported receiving consulting fees from Amgen, Biohaven Pharmaceuticals, Eli Lilly and Company, Novartis Pharmaceutical, Satsuma Pharmaceuticals, and Lundbeck; he also reported serving on the executive board of the American Headache Society. Dr Gioia reported authorship of the postconcussion inventory tool used in the study. Dr Giza reported receiving grants from UCLA Steve Tisch BrainSPORT Program, UCLA Easton Clinic for Brain Health, UCLA Brain Injury Research Center, and an unrestricted gift from Stan and Patti Silver during the conduct of the study; he reported receiving grants from the National Collegiate Athletic Association, the US Department of Defense, and the National Institute of Neurological Disorders and Stroke outside the submitted work; he reported receiving personal fees from Highmark Interactive and Novartis Pharmaceutical, as well as owning stock options from Highmark Interactive; he reported serving as a clinical consultant for the National Basketball Association, the National Football League Neurological Care Program, the National Hockey League Players Association, and the Los Angeles Lakers; he reported serving on advisory boards for Highmark Interactive (2018-2020), Novartis Pharmaceutical (2019), Major League Soccer, National Basketball Association, US Soccer Federation; and he reported receiving book royalties from Blackwell/Wiley Publishing. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Kaplan-Meier Curve for Posttraumatic Headache Recovery by Status
PTH-M indicates posttraumatic headache experienced by a patient with a migraine phenotype; PTH-NM, headache experienced by a patient without a migraine phenotype.
Figure 2.
Figure 2.. Kaplan-Meier Curve for Time to Recovery by Posttraumatic Headache Status
PTH-M indicates posttraumatic headache experienced by a patient with a migraine phenotype; PTH-NM, headache experienced by a patient without a migraine phenotype.
See this image and copyright information in PMC

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