TOPLINE:

A migraine-like phenotype occurred in 88% of adults with moderate-to-severe posttraumatic headache (PTH) 2-4 months after sustaining a mild traumatic brain injury (mTBI), new research showed. Investigators also found that triptans and migraine preventive medications were rarely used and more than half of patients who used nonopioid analgesics reported that they were ineffective.

METHODOLOGY:

• A cross-sectional study used data from a cohort study with a nested randomized controlled trial for more than 200 adults with moderate-to-severe PTH (median age, 36 years; 74% women), a headache duration of 2-4 months, and a high burden of other postconcussion symptoms in Central Denmark from 2021 to 2022.
• Overall, 62% of patients had acute PTH (duration, < 3 months) and 38% had persistent PTH (duration, ≥ 3 months).
• Data on demographic and trauma-related characteristics were collected 2-4 months after mTBI through patient-reported questionnaires, and loss of consciousness and comorbid disorders were assessed 2-7 months after mTBI during clinical evaluation.
• A modified headache questionnaire was developed, consisting of 56 questions covering trauma mechanism, history and characteristics of headache, including frequency, localization, quality, intensity, and treatment patterns. An algorithm linking questionnaire data to International Classification of Headache Disorders, third edition (ICHD-3), criteria was developed to classify individuals into 1 of 13 predefined phenotypes.

TAKEAWAY:

• A migraine-like or probable migraine-like phenotype was identified in 88% of patients, with no significant differences in phenotype distribution between acute and persistent headache subgroups or between men and women. Additionally, 6% of participants had a tension-type headache (TTH)-like phenotype and 3% had a probable TTH-like phenotype.
• Headache frequency of 15 or more days per month occurred in 78% of patients, with an average intensity of moderate or severe in 94%. The most frequent headache quality was a pressing and/or tightening, reported by 85% of patients.
• Preventive medications and triptans were only used by 7% and 4% of participants, respectively. Nonopioid analgesics were used by 88% of patients, but 52% reported a lack of efficacy. Current or previous use of opioids was reported by 9%, with 40% reporting no efficacy.
• Probable medication overuse headache was found in 27% of patients and 33% reported having tried at least two nonpharmacologic treatments. Physiotherapy was the most common of these treatments (used by 51%), but 67% reported a lack of efficacy.

IN PRACTICE:

“These findings underscore the need to monitor both efficacy and side effects of pharmacological treatments in PTH patients,” the investigators wrote.

“Further research should focus on disease-specific treatment strategies and their effectiveness in the early phase of PTH,” they added.

SOURCE:

The study was led by Charlotte Nygaard, Aarhus University, Hammel, Denmark. It was published online on March 10 in Cephalalgia.

LIMITATIONS:

Use of an unvalidated patient-reported headache questionnaire and modifications to ICHD-3 may have caused misclassification and overestimation of migraine-like phenotypes. Patient-reported headache history, medication use, and comorbidities prior to mTBI were subject to recall bias. Treatment-effect estimates did not account for interactions between multiple therapies and may be biased by self-reporting. Additionally, the inability to distinguish current from prior acute medication use further limited comparability with other pharmacologic studies.

DISCLOSURES:

The study was funded by the Health Research Fund of Central Denmark Region. The investigators reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.