Evaluation of Posttraumatic Headache Phenotype and Recovery Time After Youth Concussion

Kamins, Joshua; Richards, Rachel; Barney, Bradley J.; Locandro, Christopher; Pacchia, Christina F.; Charles, Andrew; Cook, Lawrence J.; Gioia, Gérard A.; Giza, Christopher C.; Blume, Heidi K.

doi:10.1001/jamanetworkopen.2021.1312

Cited by 29 publications

(37 citation statements)

References 27 publications

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“…A predisposition to migraine appears to act as a catalyst for PTH development, 48 and some cases of PTH may be the abrupt onset of trauma‐triggered migraine 11 . A recent prospective multicenter cohort study demonstrated that those reporting migrainous headache <8 weeks post‐mTBI were more likely to have a prolonged recovery, and were more likely to be prescribed preventative migraine medication 9 . The authors proposed that migraine phenotype may represent a target for early intervention.…”

Section: Discussionmentioning

confidence: 99%

“…Prior work in children suggests that PTH with migrainous features 5‐9 or a personal or family history of migraine is associated with prolonged recovery 5,6 . The PTH “migraine phenotype” may represent a subset of patients who would benefit from more directed headache management 9 . This is of particular interest in the pediatric population due to the high incidence of migraine in the teenage years and early twenties 10 .…”

Section: Introductionmentioning

confidence: 99%

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Acute and chronic management of posttraumatic headache in children: A systematic review

Gentile

Shah

Irwin³

et al. 2021

Headache

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Objectives The goal of this paper is to provide a compilation of the evidence for the treatment of posttraumatic headache (PTH) in the pediatric population. Headache features and timing of therapy were considered. Background Headache is the most common symptom following mild traumatic brain injury (mTBI), affecting more than 80% of children and adolescents. It is unclear whether treatment for PTH should be tailored based on headache characteristics, particularly the presence of migraine features, and/or chronicity of the headache. Methods Systematic literature searches of PubMed, Embase, Scopus, and Cochrane databases (1985–2021, limited to English) were performed, and key characteristics of included studies were entered into RedCAP® (Prospero ID CRD42020198703). Articles and conference abstracts that described randomized controlled trials (RCTs), cohort studies, retrospective analyses, and case series were included. Participants included youth under 18 years of age with acute (<3 months) and persistent (≥3 months) PTH. Studies that commented on headache improvement in response to therapy were included. Results Twenty‐seven unique studies met criteria for inclusion describing abortive pharmacologic therapies (9), preventative pharmacotherapies (5), neuromodulation (1), procedures (5), physical therapy and exercise (6), and behavioral therapy (2). Five RCTs were identified. Studies that focused on abortive pharmacotherapies were completed in the first 2 weeks post‐mTBI, whereas other treatment modalities focused on outcomes 1 month to over 1‐year post‐injury. Few studies reported on migrainous features (7), personal history of migraine (7), or family history of migraine (3). Conclusions There is limited evidence on the timing and types of therapies that are effective for treating PTH in the pediatric population. Prospective studies that account for headache characteristics and thoughtfully address the timing of therapies and outcome measurement are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute and chronic management of posttraumatic headache in children: A systematic review

Gentile

Shah

Irwin³

et al. 2021

Headache

View full text Add to dashboard Cite

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“…Activation of trigeminal nociceptive pathways has been extensively studied in migraine pathogenesis, and may help explain why there is symptom overlap between migraine and concussion 26,27,39 . Indeed, multiple studies have proposed a migrainous concussion phenotype that has been associated with high symptom burden and prolonged recovery [40][41][42][43][44] . The brain predominant group in our study reported elevation of headache, and light and sound sensitivity, which are cardinal features of migraine 45 .…”

Section: Discussionmentioning

confidence: 99%

The relationship between visually evoked effects and concussion in youth

Gentile

Aguirre

Arbogast

et al. 2021

Preprint

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Increased sensitivity to light is common following concussion. Viewing a flickering light can also produce uncomfortable somatic sensations like nausea or headache. Here we examined effects evoked by viewing a patterned, flickering screen in a cohort of 81 uninjured youth athletes and 84 youth with concussion. We used exploratory factor analysis and identified two primary dimensions of variation: the presence or absence of visually evoked effects, and variation in the tendency to manifest effects that localized to the eyes (e.g., eye watering), versus more generalized neurologic symptoms (e.g., headache). Based on these two primary dimensions, we grouped participants into three categories of evoked symptomatology: no effects, eye-predominant effects, and brain-predominant effects. A similar proportion of participants reported eye-predominant effects in the uninjured (33.3%) and concussion (32.1%) groups. By contrast, participants who experienced brain-predominant effects were almost entirely from the concussion group (1.2% of uninjured, 35.7% of concussed). The presence of brain-predominant effects was associated with a higher concussion symptom burden and reduced performance on visio-vestibular tasks. Our findings indicate that the experience of negative constitutional, somatic sensations in response to a dynamic visual stimulus is a salient marker of concussion and is indicative of more severe concussion symptomatology. We speculate that differences in visually evoked effects reflect varying levels of activation of the trigeminal nociceptive system.

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“…In a recent study by the Four Corners Youth Consortium, PTH with a migraine phenotype strongly predicted persistent headache at 3- and 6-months post injury, compared to PTH with a non-migraine phenotype. Although female gender has long been considered a risk factor for prolonged recovery after concussion, this cohort demonstrated that the discrepancy in persistent PTH by gender was explained by a higher likelihood of migraine phenotype in girls [ 9 ].…”

Section: Acute Pth Treatment Modelsmentioning

confidence: 99%

“…Current insurance requirements make targeted CGRP intervention with antibodies and gepants difficult in acute PTH. However, for patients at a high risk of developing persistent symptoms based on clinical risk scores, and perhaps, given the work of Kamins et al [ 9 ], those who have PTH with a migraine phenotype, urgent efficacy studies are needed. In their absence, the author has found that employing corticosteroids, NSAIDs, or long lasting triptans like frovatriptan for a 5-7 day course may be effective to significantly diminish symptoms and shorten the acute symptom course after concussion.…”

Section: Acute Pth Treatment Modelsmentioning

confidence: 99%

Models for Treating Post-traumatic Headache

Kamins

2021

Curr Pain Headache Rep

Self Cite

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Purpose of Review To discuss the treatment of post-traumatic headache (PTH) and how to choose pharmacotherapy based upon known pathophysiology. Recent Findings Preclinical models of traumatic brain injury are finally revealing some of the mechanisms of PTH, including the significant role that inflammatory neuropeptides like calcitonin gene-related peptide (CGRP) play in the initiation and persistence of symptoms. Summary To effectively treat post-traumatic headache (PTH), one needs to understand the pathophysiology behind the initiation and persistence of symptoms. Recent animal models are starting to elucidate these mechanisms, but effective treatment will also likely rely on the identification of patients who are most at risk for persistent PTH. Trials of early, targeted therapy for at-risk patients will be needed to validate these hypotheses. Additionally, high powered clinical trials are lacking in the field of persistent PTH for medications that are known to be effective in primary headache disorders. Effective treatment for persistent PTH also requires understanding how headache interacts with the complex nature of persistent post-concussion symptoms, as this disease often necessitates a multi-disciplinary approach. Regardless, with the knowledge gained by new PTH models cited in this paper, and an increasing availability of novel headache medications, more effective treatment models are on the horizon.

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Evaluation of Posttraumatic Headache Phenotype and Recovery Time After Youth Concussion

Cited by 29 publications

References 27 publications

Acute and chronic management of posttraumatic headache in children: A systematic review

Acute and chronic management of posttraumatic headache in children: A systematic review

The relationship between visually evoked effects and concussion in youth

Models for Treating Post-traumatic Headache

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