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

Abstract

Objective: To investigate the impact of having headaches prior to traumatic brain injury (TBI) on headache features and long-term patient health outcomes. Background and Methods: This was an exploratory analysis of patients with TBI who were enrolled in the American Registry for Migraine Research (ARMR), a multicenter, prospective, longitudinal patient registry composed of patients with International Classification of Headache Disorders, 3rd edition (ICHD-3)-defined headache diagnoses. The ARMR study enrolled 2,707 patients between February 1, 2016 and May 6, 2020, 565 of whom qualified for this analysis. Those with headaches prior to their TBI were compared to those without headaches prior to their TBI for ICHD-3 diagnoses, headache frequency and intensity, headache-related disability (Migraine Disability Assessment score), symptoms of anxiety (General Anxiety Disorder [GAD-7]), depression (two items from Patient Health Questionnaire-9), post-traumatic stress disorder (PTSD), cutaneous allodynia (12-item Allodynia Symptom Checklist [ASC-12]), cognitive dysfunction (Migraine Attacks Subjective Cognitive Impairments Scale [Mig-SCog]), pain interference (Patient-Reported Outcomes Measurement Information System-Pain Interference), and work productivity (Work Productivity and Activity Impairment).Results: Among 565 participants with TBI, 350 had headaches prior to their TBI. Those with pre-TBI headaches were less likely to receive a diagnosis of post-traumatic headache (PTH; 14/350 [4.0%] vs. 21/215 [9.8%], p = 0.006), even though 25.7% reported new or worsening headaches within 7 days of their TBI. Those with pre-TBI headaches had higher ASC-12 scores (2.4 ± 3.5 vs. 1.8 ± 3.4, p = 0.030), Mig-SCog scores (9.3 ± 4.7 vs. 8 ± 4.9, p = 0.004), and GAD-7 scores (6.9 ± 5.1 vs. 6.2 ± 5.4, p = 0.039), and were more likely to have a migraine diagnosis (335/350 [95.7%] vs. 192/215 [89.3%], p = 0.003). Conclusions:Those with headaches prior to TBI are less likely to receive a diagnosis of PTH. They have more severe symptoms of cutaneous allodynia, cognitive impairment,

Sensory hypersensitivities are associated with post‐traumatic headache‐related disability

“…Per ARMR inclusion criteria, patients were 18 years of age or older, fluent in English, had a primary or secondary headache disorder diagnosis, could access a computer or comparable device with Internet access, and were able and willing to provide informed consent. Previous reports of these data have analyzed mild traumatic brain injury, 15,16 depression and anxiety, 17 white matter hypersensitivities, 18 and broad findings of the study 14 …”

Posttraumatic headache is a distinct headache type from migraine

“…The ICHD-3 criteria for PTH account for a common clinical scenario in which individuals have headaches prior to their mTBI. This scenario is frequent [5,6] because migraine is a common disease with a prevalence of 14.0% in the general population [7] and preexisting migraine is a risk factor for developing PTH [12]. When a person has pre-TBI headaches that substantially worsen following a TBI, the individual receives two headache diagnoses: a diagnosis of preinjury headache, such as migraine or tension-type headache (TTH), and PTH.…”

“…This aspect of PTH should be investigated rigorously, as the overlap of PTH and migraine has led to the underdiagnosis of PTH. An observational study within the American Registry for Migraine Research demonstrated that amongst 565 participants with TBI (93.3% of whom received a migraine diagnosis), 25.7% reported new or worsening headaches within seven days of their injury [5]. However, only 17.2% of these individuals received a PTH diagnosis, with those who had headaches prior to their TBI being less likely to receive a PTH diagnosis compared to those without pre-TBI headaches.…”

“…[4]. In this scenario, the patient receives two diagnoses: one for PTH and one for the preexisting headache such as a migraine [5,6]. Because migraine is a highly prevalent disorder [7] and it is a risk factor for developing PTH, it is common for those with PTH to have preinjury migraine.…”

Trainee highlights

“…His research interests include traumatic brain injury and posttraumatic headache. We hope to see much more from him down the road, in his long career ahead! 3 …”