Early prophylactic treatment reduces development of chronic post traumatic headache after concussion

Abstract

BackgroundHeadaches after concussion are common, potentially debilitating, and long lasting. There are currently no guidelines on the treatment of post traumatic headaches (PTH). The aim of this study is to investigate the effects of early prophylactic pharmacologic treatment on the development of chronic post traumatic headaches (cPTH) in adolescent and adult concussion patients.MethodsPatients were retrospectively enrolled from the patient population at the Barrow Concussion and Brain Injury Center (Phoenix, AZ) from the previous 5 years. Males and females ages 13 and older with a diagnosis of PTH attributed to mild head injury based on ICHD2 criteria who were offered a headache prophylactic medication were included. Patients were divided into 3 groups: those who did not take treatment (Untreated), those who took nortriptyline (Nor), and those who took topiramate (Top). Groups were subdivided into those that developed cPTH and those who did not (ncPTH). The average time from injury to start of treatment (SoT) in days were analyzed using t-tests within and between groups.ResultsOne hundred twenty patients met inclusion criteria for the study (Untreated = 36, Top = 46, Nor = 38). Overall, 64 of 120 patients met criteria for cPTH (53%). SoT and development of cPTH is significant overall (35 vs 23, p< 0.001). SoT is significant for Untreated (NcPTH 14.4 vs cPTH 35.6, p = 0.001) and Top (NcPTH 23.9 vs cPTH 35.5, p = 0.002), but not for Nor (NcPTH 31.9 vs cPTH 34.0, p = 0.372). For NcPTH there is a significant difference between SoT for Untreated and Top (14.4 vs 23.9, p = 0.04) and Untreated vs Nor (14.4 vs 31.9, p = 0.002), but not Top and Nor (23.9 vs 31.9, p = 0.09). For cPTH there is no difference for SoT between groups.ConclusionEarly intervention with nonpharmacologic treatments and topiramate is associated with reduced development of cPTH.