Håkan Ashina1, Afrim Iljazi1, Haidar Muhsen Al-Khazali1, Sait Ashina2,3, Rigmor Højland Jensen1, Faisal Mohammad Amin1, Messoud Ashina1, Henrik Winther Schytz1. 1. Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. 2. Comprehensive Headache Center, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. 3. Comprehensive Headache Center, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Abstract
OBJECTIVE: To investigate clinical characteristics and treatment patterns in persistent post-traumatic headache attributed to mild traumatic brain injury. METHODS: A total of 100 individuals with persistent post-traumatic headache attributed to mild traumatic brain injury were enrolled between July 2018 and June 2019. Deep phenotyping was performed using a semi-structured interview while allodynia was assessed using the 12-item Allodynia Symptom Checklist. RESULTS: In 100 subjects with persistent post-traumatic headache, the mean headache frequency was 25.4 ± 7.1 days per month. The most common headache phenotype was chronic migraine-like headache (n = 61) followed by combined episodic migraine-like and tension-type-like headache (n = 29) while nine subjects reported "pure" chronic tension-type-like headache. The most frequent trigger factors were stress, lack of sleep, and bright lights. A history of preventive medication use was reported by 63 subjects, of which 79% reported failure of at least one preventive drug, while 19% reported failure of at least four preventive drugs. Cutaneous allodynia was absent in 54% of the subjects, mild in 23%, moderate in 17%, and severe in 6%. CONCLUSIONS: The headache profile of individuals with persistent post-traumatic headache most often resembled a chronic migraine-like phenotype or a combined episodic migraine-like and tension-type-like headache phenotype. Migraine-specific preventive medications were largely reported to be ineffective. Therefore, there is a pressing need for pathophysiological insights and disease-specific therapies.
OBJECTIVE: To investigate clinical characteristics and treatment patterns in persistent post-traumatic headache attributed to mild traumatic brain injury. METHODS: A total of 100 individuals with persistent post-traumatic headache attributed to mild traumatic brain injury were enrolled between July 2018 and June 2019. Deep phenotyping was performed using a semi-structured interview while allodynia was assessed using the 12-item Allodynia Symptom Checklist. RESULTS: In 100 subjects with persistent post-traumatic headache, the mean headache frequency was 25.4 ± 7.1 days per month. The most common headache phenotype was chronic migraine-like headache (n = 61) followed by combined episodic migraine-like and tension-type-like headache (n = 29) while nine subjects reported "pure" chronic tension-type-like headache. The most frequent trigger factors were stress, lack of sleep, and bright lights. A history of preventive medication use was reported by 63 subjects, of which 79% reported failure of at least one preventive drug, while 19% reported failure of at least four preventive drugs. Cutaneous allodynia was absent in 54% of the subjects, mild in 23%, moderate in 17%, and severe in 6%. CONCLUSIONS: The headache profile of individuals with persistent post-traumatic headache most often resembled a chronic migraine-like phenotype or a combined episodic migraine-like and tension-type-like headache phenotype. Migraine-specific preventive medications were largely reported to be ineffective. Therefore, there is a pressing need for pathophysiological insights and disease-specific therapies.
Entities:
Keywords:
Concussion; clinical management; head injury; head trauma
Authors: Colt Coffman; Deborah Reyes; Mary Catherine Hess; Alec M Giakas; Melinda Thiam; Jason Jonathon Sico; Elizabeth Seng; William Renthal; Charles Rhoades; Guoshuai Cai; X Michelle Androulakis Journal: Neurology Date: 2022-04-25 Impact factor: 11.800
Authors: Ellen Parker; Refat Aboghazleh; Griffin Mumby; Ronel Veksler; Jonathan Ofer; Jillian Newton; Rylan Smith; Lyna Kamintsky; Casey M A Jones; Eoin O'Keeffe; Eoin Kelly; Klara Doelle; Isabelle Roach; Lynn T Yang; Pooyan Moradi; Jessica M Lin; Allison J Gleason; Christina Atkinson; Chris Bowen; Kimberly D Brewer; Colin P Doherty; Matthew Campbell; David B Clarke; Gerben van Hameren; Daniela Kaufer; Alon Friedman Journal: Brain Date: 2022-06-30 Impact factor: 15.255