Persistent Post-Traumatic Headache and Migraine: Pre-Clinical Comparisons

Capi, Matilde; Pomes, Leda Marina; Andolina, Giulia; Curto, Martina; Martelletti, Paolo; Lionetto, Luana

doi:10.3390/ijerph17072585

Cited by 30 publications

(39 citation statements)

References 64 publications

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“…Patients with persistent post-traumatic headache (PPTH) and patients with migraine have similar phenotypes (1–3). Migraine is the most common headache phenotype in patients with PPTH in clinic-based studies (4).…”

Section: Introductionmentioning

confidence: 99%

Distinguishing persistent post-traumatic headache from migraine: Classification based on clinical symptoms and brain structural MRI data

et al. 2021

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Background Persistent post-traumatic headache most commonly has symptoms that overlap those of migraine. In some cases, it can be clinically difficult to differentiate persistent post-traumatic headache with a migraine phenotype from migraine. The objective of this study was to develop a classification model based on questionnaire data and structural neuroimaging data that distinguishes individuals with migraine from those with persistent post-traumatic headache. Methods Questionnaires assessing headache characteristics, sensory hypersensitivities, cognitive functioning, and mood, as well as T1-weighted magnetic resonance imaging and diffusion tensor data from 34 patients with migraine and 48 patients with persistent post-traumatic headache attributed to mild traumatic brain injury were included for analysis. The majority of patients with persistent post-traumatic headache had a migraine/probable migraine phenotype (77%). A machine-learning leave-one-out cross-validation algorithm determined the average accuracy for distinguishing individual migraine patients from individual patients with persistent post-traumatic headache. Results Based on questionnaire data alone, the average classification accuracy for determining whether an individual person had migraine or persistent post-traumatic headache was 71.9%. Adding imaging data features to the model improved the classification accuracy to 78%, including an average accuracy of 97.1% for identifying individual migraine patients and an average accuracy of 64.6% for identifying individual patients with persistent post-traumatic headache. The most important clinical features that contributed to the classification accuracy included questions related to anxiety and decision making. Cortical brain features and fibertract data from the following regions or tracts most contributed to the classification accuracy: Bilateral superior temporal, inferior parietal and posterior cingulate; right lateral occipital, uncinate, and superior longitudinal fasciculus. A post-hoc analysis showed that compared to incorrectly classified persistent post-traumatic headache patients, those who were correctly classified as having persistent post-traumatic headache had more severe physical, autonomic, anxiety and depression symptoms, were more likely to have post-traumatic stress disorder, and were more likely to have had mild traumatic brain injury attributed to blasts. Discussion A classification model that included a combination of questionnaire data and structural imaging parameters classified individual patients as having migraine versus persistent post-traumatic headache with good accuracy. The most important clinical measures that contributed to the classification accuracy included questions on mood. Regional brain structures and fibertracts that play roles in pain processing and pain integration were important brain features that contributed to the classification accuracy. The lower classification accuracy for patients with persistent post-traumatic headache compared to migraine may be related to greater heterogeneity of patients in the persistent post-traumatic headache cohort regarding their traumatic brain injury mechanisms, and physical, emotional, and cognitive symptoms.

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Section: Introductionmentioning

confidence: 99%

Distinguishing persistent post-traumatic headache from migraine: Classification based on clinical symptoms and brain structural MRI data

et al. 2021

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“…The main phenotype of PTH in patients with mTBI is consistent with that of migraine [ 5 , 6 ], and PTH commonly has characteristics similar to migraine. Thus, there are shared underlying neurochemical mechanisms between migraine and PTH [ 7 ]. Several studies have shown that various brain structures, such as the brainstem, central dopaminergic system and hypothalamus, are involved in the pathophysiology of migraine [ 8 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

Altered hypothalamic functional connectivity in post-traumatic headache after mild traumatic brain injury

Wang

et al. 2020

J Headache Pain

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Background Post-traumatic headache (PTH) is one of the most frequent symptoms following mild traumatic brain injury (mTBI). Neuroimaging studies implicate hypothalamic function connectivity (FC) disruption as an important factor in pain disorders. However, it is unknown whether there are alterations in the hypothalamus-based resting state FC within PTH following mTBI at the acute stage and its relationship with headache symptom measurement. Methods Forty-four mTBI patients with PTH, 27 mTBI patients without PTH and 43 healthy controls who were well matched for age, gender, and years of education were enrolled in this study. All participants underwent resting-state functional magnetic resonance imaging (fMRI) scanning as well as headache symptom measurement and cognitive assessment. Hypothalamic resting state networks were characterized by using a standard seed-based whole-brain correlation method. The bilateral hypothalamic FC was compared among the three groups. Furthermore, the correlations between hypothalamic resting state networks and headache frequency, headache intensity and MoCA scores was investigated in mTBI patients with PTH using Pearson rank correlation. Results Compared with mTBI patients without PTH, mTBI patients with PTH at the acute stage presented significantly decreased left hypothalamus-based FC with the right middle frontal gyrus (MFG) and right medial superior frontal gyrus (mSFG), and significantly decreased right hypothalamus-based FC with the right MFG. Decreased FC of the right MFG was significantly positively associated with headache frequency and headache intensity ( r = 0.339, p = 0.024; r = 0.408, p = 0.006, respectively). Decreased FC of the right mSFG was significantly positively associated with headache frequency and headache intensity ( r = 0.740, p < 0.0001; r = 0.655, p < 0.0001, respectively). Conclusion Our data provided evidence of disrupted hypothalamic FC in patients with acute mTBI with PTH, while abnormal FC significantly correlated with headache symptom measurement. Taken together, these changes may play an essential role in the neuropathological mechanism of mTBI patients with PTH.

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“…The debate on the relationship between mTBI, migraine, PTH, and PTSD has not yet found a definitive position [79,80]. It is unclear whether a head trauma triggers a biologically unique headache condition or whether the head pain mechanisms share migraine or tension-type pathways.…”

Section: Resultsmentioning

confidence: 99%

Position Paper on Post-Traumatic Headache: The Relationship Between Head Trauma, Stress Disorder, and Migraine

Lambru¹,

Benemei

Andreou

et al. 2020

Pain Ther

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Traumatic brain injury (mTBI) is a major public health concern, with mild TBI (mTBI) constituting the vast majority of the injuries. Posttraumatic headache (PTH) is one of the most frequent symptoms that follow a mTBI, occurring in isolation with a tension-type or migraine phenotype, or more often as part of a complex neurobehavioural array of symptoms. The existence of PTH as a separate entity from the primary headaches is still a matter of debate. Classification issues and a lack of methodologically robust epidemiological and clinical studies have made it difficult to elucidate the mechanisms underlying acute and even more assessing the efficacy of this class of treatments are underway. The broad overlap between PTH, migraine, and PTSD suggests that research in this field should start with a re-appraisal of the diagnostic criteria, followed by methodologically sound epidemiological and clinical studies. Preclinical research should strive to create more reliable PTH models to support human neuroimaging, neurochemical, and neurogenetic studies, aiming to underpin new pathophysiological hypotheses that may expand treatment targets and improve the management of PTH patients.

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Persistent Post-Traumatic Headache and Migraine: Pre-Clinical Comparisons

Cited by 30 publications

References 64 publications

Distinguishing persistent post-traumatic headache from migraine: Classification based on clinical symptoms and brain structural MRI data

Distinguishing persistent post-traumatic headache from migraine: Classification based on clinical symptoms and brain structural MRI data

Altered hypothalamic functional connectivity in post-traumatic headache after mild traumatic brain injury

Position Paper on Post-Traumatic Headache: The Relationship Between Head Trauma, Stress Disorder, and Migraine

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