Post-Traumatic Migraine Tied to Longer Recovery After Youth Concussion

(Reuters Health) – Youth who sustain mild traumatic brain injuries may have a longer recovery when they experience migraines than with other types of post-traumatic headache, a new study suggests.

Researchers examined data on 281 youth ranging in age from 5 to 18 years who received treatment for a total of 286 concussions from December 2017 to June 2019. Patients were all enrolled when they presented for treatment, within 8 weeks of injury.

At the initial visit, 96 concussions involved no headache symptoms, while 133 involved migraine, and 57 involved non-migraine headache.

At 3 months, a significantly larger proportion of patients with migraine at baseline had headache (29.3%) than was the case for patients with non-migraine headache (12.2%) or no headache (11.4%) at baseline. While a larger proportion of patients with migraine also had headache at 6 months, these results were not statistically significant.

Median time to recovery was significantly longer with migraine (95 days) than with non-migraine headache (41) or without headache (67), the study also found.

“Our paper demonstrates that in children and adolescents, post-traumatic headaches of a migraine type are associated with a more prolonged recovery as compared to youth with no headache or non-migraine headaches,” said lead study author Dr. Joshua Kamins, an assistant clinical professor of neurology at the David Geffen School of Medicine at the University of California, Los Angeles.

Certain patient characteristics were associated with migraine, including female sex, depression at baseline, older age, history of migraine, family history of ADHD, and public health insurance.

“In a clinical setting, this suggests that patients with migrainous post-traumatic headaches, especially girls, should be observed more closely, and potentially referred earlier to headache specialists,” Dr. Kamins said by email.

One limitation of the study is that the exclusion criteria left out youth with severe headache at baseline, and also excluded a larger proportion of males, patients with a family history of ADHD, and people on public insurance, the study team notes in JAMA Network Open.

It’s possible that patients with migraine had more concussion symptoms in general, which contributed to a longer recovery compared with patients who didn’t have migraine, the researchers also point out.

Recall bias might have also influenced how patients described any headache history, with the potential for youth who sustained concussions to report pre-injury headaches as far milder than they really were, the study team adds.

However, headaches with a migrainous phenotype are often debilitating and prevent patients from participating in daily activities like school, as well physical activity, said Dr. Rachel Pearson, director of brain injury medicine and a pediatric neurologist at Children’s Hospital Orange County, and an assistant clinical professor at the University of California, Irvine.

“In addition, they may disrupt sleep either because patients are unable to sleep at night time due to headaches or they end up sleeping during the day because sleep relieves their headache and then have circadian disturbance,” Dr. Pearson, who wasn’t involved in the study, said by email. “Poor sleep then becomes another factor keeping patients from returning to their normal daily routine.”

Clinicians who care for youth with concussion must understand risk factors for prolonged recovery in order to identify those patients who are high-risk early on, and provide them with targeted intervention that may ultimately alter their recovery trajectory, Dr. Pearson added.

“This study tells us that patients with post-traumatic headache, and those with post-traumatic headache with a migrainous phenotype in particular, within the first 8 weeks of their injury, have higher risk for prolonged recovery and may benefit from such early interventions,” Dr. Pearson said.

SOURCE: JAMA Network Open, online March 8, 2021.

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