Abstract
BackgroundThe majority of individuals with post-traumatic headache have symptoms that are indistinguishable from migraine. The overlap in symptoms amongst these individuals raises the question as to whether post-traumatic headache has a unique pathophysiology or if head trauma triggers migraine. The objective of this study was to compare brain structure in individuals with persistent post-traumatic headache (i.e. headache lasting at least 3 months following a traumatic brain injury) attributed to mild traumatic brain injury to that of individuals with migraine.MethodsTwenty-eight individuals with persistent post-traumatic headache attributed to mild traumatic brain injury and 28 individuals with migraine underwent brain magnetic resonance imaging on a 3 T scanner. Regional volumes, cortical thickness, surface area and curvature measurements were calculated from T1-weighted sequences and compared between subject groups using ANCOVA. MRI data from 28 healthy control subjects were used to interpret the differences in brain structure between migraine and persistent post-traumatic headache.ResultsDifferences in regional volumes, cortical thickness, surface area and brain curvature were identified when comparing the group of individuals with persistent post-traumatic headache to the group with migraine. Structure was different between groups for regions within the right lateral orbitofrontal lobe, left caudal middle frontal lobe, left superior frontal lobe, left precuneus and right supramarginal gyrus (p < .05). Considering these regions only, there were differences between individuals with persistent post-traumatic headache and healthy controls within the right lateral orbitofrontal lobe, right supramarginal gyrus, and left superior frontal lobe and no differences when comparing the migraine cohort to healthy controls.ConclusionsIn conclusion, persistent post-traumatic headache and migraine are associated with differences in brain structure, perhaps suggesting differences in their underlying pathophysiology. Additional studies are needed to further delineate similarities and differences in brain structure and function that are associated with post-traumatic headache and migraine and to determine their specificity for each of the headache types.
Highlights
The majority of individuals with post-traumatic headache have symptoms that are indistinguishable from migraine
Comparing the patients with persistent post-traumatic headache (PTH)” (PPTH) to those with migraine, there were no differences in age (PPTH: 35.1 +/− 9.6 years vs. Migraine: 37.5 +/− 8.5 years, p = .33) or headache frequency (16.6 +/− 7.8 days per month vs. 16.4 +/− 8.1 days per month, p = .93)
The main finding of this study is that there are differences in brain structure between patients who have PPTH and those with migraine, perhaps suggesting that these two headache types are associated with distinct underlying pathophysiology despite their substantial similarities in symptoms
Summary
The majority of individuals with post-traumatic headache have symptoms that are indistinguishable from migraine. The majority of individuals with post-traumatic headache (PTH) have headache characteristics that are consistent with a migraine phenotype [1,2,3,4]. For the patient without a history of migraine who has head trauma and develops headache immediately following the trauma, the diagnosis of PTH is rather straightforward. Even in such a situation, it is not clear if the head trauma caused a unique headache type (i.e. PTH) with a unique underlying pathophysiology or if the trauma unmasked an underlying propensity toward the development of migraine. Identification of differences in the pathophysiology of migraine and PTH would support the notion that migraine and PTH are truly distinct headache types
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