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. 2023 Sep;63(8):1061-1069.
doi: 10.1111/head.14604. Epub 2023 Aug 28.

Sensory hypersensitivities are associated with post-traumatic headache-related disability

Cecilia Martindale  1 , Angela P Presson  1 , Todd J Schwedt  2 , K C Brennan  1 , Melissa M Cortez  1
Affiliations

Sensory hypersensitivities are associated with post-traumatic headache-related disability

Cecilia Martindale et al. Headache. 2023 Sep.

Abstract

Objective: To examine whether sensory hypersensitivity contributes to headache-related disability in a secondary analysis of patients with post-traumatic headache.

Background: Up to one-third of individuals with traumatic brain injuries report persistent headache 3 months post-injury. High rates of allodynia and photophobia have been observed in clinical studies and animal models of post-traumatic headache, but we do not fully understand how sensory amplifications impact post-traumatic headache-related disability.

Methods: We identified a cross-sectional sample of patients from the American Registry for Migraine Research database with new or worsening headaches post-head injury from 2016 to 2020 and performed a secondary analysis of those data. We modeled the relationship between sensory sensitivity and Migraine Disability Assessment scores using questionnaires. Candidate variables included data collection features (study site and year), headache-related and general clinical features (headache frequency, migraine diagnosis, abuse history, sex, age, cognitive and affective symptom scores), and sensory symptoms (related to light, sound, and touch sensitivity).

Results: The final sample included 193 patients (median age 46, IQR 22; 161/193, 83.4% female). Migraine Disability Assessment scores ranged from 0 to 260 (median 47, IQR 87). The final model included allodynia, hyperacusis, photosensitivity, headache days per month, abuse history, anxiety and depression, cognitive dysfunction, and age (R2 = 0.43). An increase of one point in allodynia score corresponded to a 3% increase in headache disability (95% CI: 0%-7%; p = 0.027), an increase of one-tenth of a point in the photosensitivity score corresponded to a 12% increase (95% CI: 3%-25%; p = 0.002), and an increase of one point in the hyperacusis score corresponded to a 2% increase (95% CI: 0%-4%; p = 0.016).

Conclusions: Increased photosensitivity, allodynia, and hyperacusis were associated with increased headache-related disability in this sample of patients with post-traumatic headache. Symptoms of sensory amplification likely contribute to post-traumatic headache-related disability and merit an ongoing investigation into their potential as disease markers and treatment targets.

Keywords: allodynia; concussion; hyperacusis; photophobia; post-traumatic headache; traumatic brain injury.

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Conflict of interest statement

CONFLICT OF INTEREST STATEMENT

Cecilia Martindale has no conflicts of interest. Angela P. Presson has no conflicts of interest. Todd J. Schwedt, within the prior 24 months, has received compensation for consulting from AbbVie, Allergan, Axsome, BioDelivery Sciences, Click Therapeutics, Collegium, Eli Lilly, Ipsen, Linpharma, Lundbeck, Satsuma, Theranica, and Tonix Pharma. He has received royalties from Up To Date and has stock options in Aural Analytics and Nocira. He has received research funding from Amgen, Henry Jackson Foundation, Mayo Clinic, National Institutes of Health, Patient Centered Outcomes Research Institute, SPARK Neuro, and the United States Department of Defense. K. C. Brennan has received research support from the National Institutes of Health, as well as support within the past 24 months for consulting (unrelated to the present work) from AbbVie/Allergan. Melissa M. Cortez has received support within the past 24 months for research from Amgen and the National Institutes of Health (unrelated to the present work).

Figures

FIGURE 1
FIGURE 1
Sample selection flow diagram.
See this image and copyright information in PMC

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