Identifying Migraine Phenotype Post Traumatic Headache (MPTH) to Guide Overall Recovery From Traumatic Brain Injury

Klein, Susan K.; Brown, Cynthia B.; Ostrowski‐Delahanty, Sarah; Bruckman, David; Victorio, M. Cristina

doi:10.1177/08830738221100327

Cited by 4 publications

(5 citation statements)

References 33 publications

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“…Kamins et al found that posttraumatic migraine was associated with prolonged time to recovery compared with no migraine and no headache in children recruited from specialty concussion clinics within 8 weeks of injury. Similarly, Klein et al identified PTH migraine phenotype using the 3-item ID Migraine Screener in children presenting to a hospital brain injury program up to 1 year after concussion. Children with migraine phenotype took longer to recover than those with nonmigraine phenotype; the study did not include children with orthopedic injury or no PTH.…”

Section: Discussionmentioning

confidence: 99%

“…3 Emerging research suggests that PTH with migraine features is associated with persisting symptoms after concussion; however, previous studies are limited by small sample sizes, samples consisting only of athletes or recruited from specialty clinics beyond 1 month after injury, and lack of an orthopedic injury (OI) comparison group. [8][9][10] Moreover, little is known about whether the postacute PTH phenotype is independently associated with prolonged recovery after controlling for known risk factors.…”

Section: Introductionmentioning

confidence: 99%

“…Prior studies have identified several risk factors associated with prolonged recovery in children, including preinjury history of migraine, female sex, and increasing age, as well as past concussion with symptoms lasting more than 1 week . Emerging research suggests that PTH with migraine features is associated with persisting symptoms after concussion; however, previous studies are limited by small sample sizes, samples consisting only of athletes or recruited from specialty clinics beyond 1 month after injury, and lack of an orthopedic injury (OI) comparison group . Moreover, little is known about whether the postacute PTH phenotype is independently associated with prolonged recovery after controlling for known risk factors.…”

Section: Introductionmentioning

confidence: 99%

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Association of Posttraumatic Headache With Symptom Burden After Concussion in Children

et al. 2023

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ImportanceHeadache is the most common symptom after pediatric concussion.ObjectivesTo examine whether posttraumatic headache phenotype is associated with symptom burden and quality of life 3 months after concussion.Design, Setting, and ParticipantsThis was a secondary analysis of the Advancing Concussion Assessment in Pediatrics (A-CAP) prospective cohort study, conducted September 2016 to July 2019 at 5 Pediatric Emergency Research Canada (PERC) network emergency departments. Children aged 8.0-16.99 years presenting with acute (&lt;48 hours) concussion or orthopedic injury (OI) were included. Data were analyzed from April to December 2022.ExposurePosttraumatic headache was classified as migraine or nonmigraine headache, or no headache, using modified International Classification of Headache Disorders, 3rd edition, diagnostic criteria based on self-reported symptoms collected within 10 days of injury.Main Outcomes and MeasuresSelf-reported postconcussion symptoms and quality-of-life were measured at 3 months after concussion using the validated Health and Behavior Inventory (HBI) and Pediatric Quality of Life Inventory–Version 4.0 (PedsQL-4.0). An initial multiple imputation approach was used to minimize potential biases due to missing data. Multivariable linear regression evaluated the association between headache phenotype and outcomes compared with the Predicting and Preventing Postconcussive Problems in Pediatrics (5P) clinical risk score and other covariates and confounders. Reliable change analyses examined clinical significance of findings.ResultsOf 967 enrolled children, 928 (median [IQR] age, 12.2 [10.5 to 14.3] years; 383 [41.3%] female) were included in analyses. HBI total score (adjusted) was significantly higher for children with migraine than children without headache (estimated mean difference [EMD], 3.36; 95% CI, 1.13 to 5.60) and children with OI (EMD, 3.10; 95% CI, 0.75 to 6.62), but not children with nonmigraine headache (EMD, 1.93; 95% CI, −0.33 to 4.19). Children with migraine were more likely to report reliable increases in total symptoms (odds ratio [OR], 2.13; 95% CI, 1.02 to 4.45) and somatic symptoms (OR, 2.70; 95% CI, 1.29 to 5.68) than those without headache. PedsQL-4.0 subscale scores were significantly lower for children with migraine than those without headache only for physical functioning (EMD, −4.67; 95% CI, −7.86 to −1.48).Conclusions and RelevanceIn this cohort study of children with concussion or OI, those with posttraumatic migraine symptoms after concussion had higher symptom burden and lower quality of life 3 months after injury than those with nonmigraine headache. Children without posttraumatic headache reported the lowest symptom burden and highest quality of life, comparable with children with OI. Further research is warranted to determine effective treatment strategies that consider headache phenotype.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association of Posttraumatic Headache With Symptom Burden After Concussion in Children

et al. 2023

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“…Yerry et al conducted a retrospective study of onabotulinum toxin A to treat PCS [ 81 ] and showed that the patients receiving the toxin manifested significant reduction in headache frequency, intensity, and medication usage. The study also found improvements in cognitive function and quality-of-life measures.…”

Section: Treatmentmentioning

confidence: 99%

Post-Traumatic Headache: A Review of Prevalence, Clinical Features, Risk Factors, and Treatment Strategies

Mavroudis

Ciobîcă

Luca

et al. 2023

JCM

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Post-traumatic headache (PTH) is a common and debilitating consequence of mild traumatic brain injury (mTBI) that can occur over one year after the head impact event. Thus, better understanding of the underlying pathophysiology and risk factors could facilitate early identification and management of PTH. There are several factors that could influence the reporting of PTH prevalence, including the definition of concussion and PTH. The main risk factors for PTHs include a history of migraines or headaches, female gender, younger age, greater severity of the head injury, and co-occurring psychological symptoms, such as anxiety and depression. PTH clinical profiles vary based on onset, duration, and severity: tension-type headache, migraine headaches, cervicogenic headache, occipital neuralgia, and new daily persistent headache. Pharmacological treatments often consist of analgesics and non-steroidal anti-inflammatory drugs, tricyclic antidepressants, or antiepileptic medication. Cognitive behavioral therapy, relaxation techniques, biofeedback, and physical therapy could also be used for PTH treatment. Our work highlighted the need for more rigorous studies to better describe the importance of identifying risk factors and patient-centered treatments and to evaluate the effectiveness of the existing treatment options. Clinicians should consider a multidisciplinary approach to managing PTH, including pharmacotherapy, cognitive behavioral therapy, and lifestyle changes.

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“…Although significant strides have been made in treating TBI, and there have been significant improvements in clinical outcomes, the mortality rate among critically-ill patients remains high ( Hägglund, Olivecrona & Koskinen, 2022 ). Inflammation is observed to be significantly related to the prognosis of TBI patients ( Klein et al, 2022 ). Macrophage migration inhibitory factor (MIF), a proinflammatory factor, plays a vital role in stimulating macrophage adhesion and phagocytosis, cytokine production, and inhibiting macrophage migration.…”

Section: Introductionmentioning

confidence: 99%

Retrospective study on the correlation between serum MIF level and the condition and prognosis of patients with traumatic head injury

Liu,

2023

PeerJ

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Objective This study aimed to investigate the correlation between serum levels of macrophage migration inhibitory factor (MIF) and the condition and prognosis of patients with traumatic brain injury (TBI). Methods A retrospective study design was used, and the clinical data of 131 TBI patients from February 2019 to January 2022 were analyzed. Patients were divided into mild (13–15 points), moderate (9–12 points), or severe (3–8 points) groups according to their Glasgow Coma Scale (GCS) score after admission. The serum levels of BDNF, MIF, and MBP in the three groups were compared, and their correlation with the severity of TBI was analyzed. Patients were then separated into a good prognosis group (4–5 points) and a poor prognosis group (≤3 points) based on their Glasgow Prognostic Score (GOS) after 6 months of follow-up. The predictive power of serum indexes and combined detection on prognosis was analyzed. Results Patients were classified into a mild group (n = 63), moderate group (n = 47), and severe group (n = 21) based on their GCS, with a significant difference noted in serum levels of MIF, MBP, and BDNF among patients with different degrees of severity (all P < 0.001). The MIF, MBP, and BDNF levels were lower in the mild group compared to the moderate (all P < 0.001) and severe group (all P < 0.001). Additionally, the MIF and BDNF levels in the moderate group were lower compared to the severe group (P = 0.011, P = 0.002). Patients with mild severity had lower serum MIF, MBP, and BDNF levels than those with other degrees, and these indexes were positively correlated with the severity of TBI (all P < 0.001, r = 0.62, r = 0.48, r = 0.58). Based on the GOS, patients were divided into a good prognosis group (n = 107) and a poor prognosis group (n = 24), with the levels of MIF, MBP, and BDNF in the good prognosis group being significantly lower than those in the poor prognosis group (P < 0.001, P = 0.007, P = 0.003). The area under the curve (AUC) of MIF was higher than that of MBP and BDNF in predicting the prognosis of TBI patients; however, the statistical differences were not significant (MIF vs. MBP, P = 0.239; MIF vs. BDNF, P = 0.211; BDNF vs. MBP, P = 0.899). The center line has a large displacement, CT annular cisterna compression, increased white blood cell count, MBP and BDNF were risk factors for prognosis in TBI patients (P = 0.005, P = 0.001, P = 0.005, P = 0.033, P = 0.044). Conclusion The serum levels of MIF, MBP, and BDNF in TBI patients were positively correlated with the severity of the disease, and MBP, BDNF levels had predictive value in determining patient prognosis.

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Identifying Migraine Phenotype Post Traumatic Headache (MPTH) to Guide Overall Recovery From Traumatic Brain Injury

Cited by 4 publications

References 33 publications

Association of Posttraumatic Headache With Symptom Burden After Concussion in Children

Association of Posttraumatic Headache With Symptom Burden After Concussion in Children

Post-Traumatic Headache: A Review of Prevalence, Clinical Features, Risk Factors, and Treatment Strategies

Retrospective study on the correlation between serum MIF level and the condition and prognosis of patients with traumatic head injury

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