Study Probes Association Between Migraine, Mild Traumatic Brain Injury

A history of mild traumatic brain injury (mTBI) is associated with disability and severity of migraine, according to study results presented at the American Headache Society's 63rd Annual Scientific Meeting, which took place June 3-6, 2021.

Head injury is a risk factor for chronic migraine, while migraine is also a risk factor for persistent and more severe headache following an mTBI or concussion, the authors explained. In addition, previous research has found posttraumatic headache (PTH) with a migraine phenotype is associated with persistent symptoms following concussion compared with nonmigraine PTH or no PTH.

However, “The prevalence of prior mTBI in patients presenting to tertiary care with migraine as a chief complaint, and the relationship between prior mTBI with the clinical features and disability associated with migraine, is not well known,” the authors wrote.

To address this knowledge gap, the researchers assessed survey responses of 1098 migraineurs without a prior diagnosis of PTH who participated in the American Registry for Migraine Research (ARMR) between 2016 and 2020. They then compared demographics, headache characteristics, Migraine Disability Assessment Scale (MIDAS), and other factors between migraineurs with a history of mTBI and those without.

Of the 1098 participants, 413 (34.5%) reported a history of mTBI, while these individuals were more likely to have dizziness (P = .006), vertigo (P = .01), and difficulty findings words (P <.001).

Analyses also revealed:

• Among the patients in the mTBI group, headaches were more likely to be triggered by lack of sleep (39.4% vs. 32.6%; P = .032), bright lights (21.4% vs 16.3%; P = .045), and reading (6.6% vs 3.0%; P = .007).
• Patients in the mTBI group had significantly greater scores on the MIDAS: 42 (interquartile range [IQR], 18-85) vs 34.5 (IQR, 15-72) (P = .010).
• Patients with a history of mTBI had a significantly higher proportion of moderate to severe Patient Headache Questionairre-4 grade (24.2% vs 20.1%; P= 0.012) and that of General Anxiety Disorder-7 grade (21.7% vs 17.3%; P = .016).

Based on the findings, the authors concluded “a history of mTBI should be assessed in patients presenting with migraine, and people with migraine who have a high exposure risk to mTBI or repetitive head impacts should be aware of the potential for migraine progression after mTBI.”

Although the underlying mechanisms of PTH and migraine are not well understood, these results indicate the conditions could have similar roots. Some headaches following TBI may also be migraine exacerbations or examples of new-onset migraine followed by injury, although PTH is typically a distinct headache type following TBI.

Reference

Ishii R, Dodick DW, Trivedi M, Dumkrieger G, Schwedt TJ. A history of mild traumatic brain injury is associated with disability and severity of migraine. Presented at: American Headache Society 2021 Virtual Annual Scientific Meeting (63rd); June 3-6, 2021. Accessed June 21, 2021. https://headachejournal.onlinelibrary.wiley.com/doi/10.1111/head.14130