Mild traumatic brain injury affects the features of migraine

Abstract

Background Headache is one of the most common symptoms after concussion, and mild traumatic brain injury (mTBI) is a risk factor for chronic migraine (CM). However, there remains a paucity of data regarding the impact of mTBI on migraine-related symptoms and clinical course. Methods Of 2161 migraine patients who participated in the American Registry for Migraine Research between February 2016 and March 2020, 1098 completed questions assessing history of TBI (50.8%). Forty-four patients reported a history of moderate to severe TBI, 413 patients reported a history of mTBI. Patients’ demographics, headache symptoms and triggers, history of physical abuse, allodynia symptoms (ASC-12), migraine disability (MIDAS), depression (PHQ-2), and anxiety (GAD-7) were compared between migraine groups with (n = 413) and without (n = 641) a history of mTBI. Either the chi-square-test or Fisher’s exact test, as appropriate, was used for the analyses of categorical variables. The Mann-Whitney test was used for the analyses of continuous variables. Logistic regression models were used to compare variables of interest while adjusting for age, gender, and CM. Results A significantly higher proportion of patients with mTBI had CM (74.3% [307/413] vs. 65.8% [422/641], P = 0.004), had never been married or were divorced (36.6% [147/402] vs. 29.4% [187/636], P = 0.007), self-reported a history of physical abuse (24.3% [84/345] vs. 14.3% [70/491], P < 0.001), had mild to severe anxiety (50.5% [205/406] vs. 41.0% [258/630], P = 0.003), had headache-related vertigo (23.0% [95/413] vs. 15.9% [102/640], P = 0.009), and difficulty finding words (43.0% [174/405] vs. 32.9% [208/633], P < 0.001) in more than half their attacks, and headaches triggered by lack of sleep (39.4% [155/393] vs. 32.6% [198/607], P = 0.018) and reading (6.6% [26/393] vs. 3.0% [18/607], P = 0.016), compared to patients without mTBI. Patients with mTBI had significantly greater ASC-12 scores (median [interquartile range]; 5 [1–9] vs. 4 [1–7], P < 0.001), MIDAS scores (42 [18–85] vs. 34.5 [15–72], P = 0.034), and PHQ-2 scores (1 [0–2] vs. 1 [0–2], P = 0.012). Conclusion Patients with a history of mTBI are more likely to have a self-reported a history of physical abuse, vertigo, and allodynia during headache attacks, headaches triggered by lack of sleep and reading, greater headache burden and headache disability, and symptoms of anxiety and depression. This study suggests that a history of mTBI is associated with the phenotype, burden, clinical course, and associated comorbid diseases in patients with migraine, and highlights the importance of inquiring about a lifetime history of mTBI in patients being evaluated for migraine.

Prevalence of depressive symptoms and its correlates in primary headache patients with a history of head-neck trauma

“…With regards to the prevalence of moderate to extremely severe levels of depressive symptoms in this study, there are no directly similar studies to compare outcomes. However, Lucas et al 13 reported similar results, such as, a prevalence of 15% for depression at baseline among patients with mild traumatic brain injury. Both studies employed standardized questionnaires to assess depressive symptoms.…”

“…Both studies employed standardized questionnaires to assess depressive symptoms. Lucas et al 13 operationalized depression as a score ≥10 on the Patient Health Questionnaire-9, while in this study, moderate-extreme levels of severe depressive symptoms were defined as a score ≥14 on the depressive subscale of the DASS-21. 8,9 The majority of cases in this study suffered from migraines followed by those with chronic-tension-type headaches.…”

Case Report: The Imperfect Association Between Craniofacial Lesion Burden and Pain in Fibrous Dysplasia

“…It is noted, however, that many patients with FD/MAS have an even earlier diagnosis and receive treatment shortly after yet still suffer from pain, headaches or migraine. Patient B not only had a much later FD diagnosis, but also experienced multiple concussions, which collectively may have contributed to or worsened her chronic craniofacial pain and migraine phenotype ( 27 , 28 ). Further insights into why Patient B has not experienced pain relief despite the use of multiple modes of therapy may be garnered by considering her feelings of helplessness or constant rumination of pain as defined by the pain catastrophizing scale.…”

The impact of pre‐morbid headaches on headache features and long‐term health outcomes following traumatic brain injury: Insights from the American Registry for Migraine Research

“…[21][22][23] There are several prior analyses that have included ARMR data and that might have included patients in this analysis. [24][25][26][27][28][29][30]…”