Sensory Hypersensitivities in Patients with Persistent Post-Traumatic Headache vs. Migraine

Abstract

Introduction & Background–Post-traumatic headache (PTH) is the most common and persistent symptom of mild traumatic brain injury (mTBI). [2] PTH is defined as a secondary headache that develops within 7 days of the head trauma. When PTH continues for at least 3 months, it is defined as persistent post-traumatic headache (PPTH). [3] The symptoms of PPTH most often resemble those of migraine. Sensory hypersensitivities to pain, light, and sound tend to heighten the severity of headaches in patients with migraine. [6] The severity and frequency of these hypersensitivities among those with PPTH has yet to be elucidated. Further defining the characteristics of PPTH and its similarities to and differences from migraine might assist with the development of future diagnostic classification criteria for PPTH. Objective–The objective of this study was to compare sensory hypersensitivities between three subject groups: PPTH, migraine, and healthy controls (HC). Research Methods–This prospective clinical study included N = 122 subjects subdivided into three groups: PPTH n = 56, Migraine n = 30, and HC n = 36. Headache diagnoses were made according to the International Classification of Headache Disorders-3 (ICHD-3) criteria. To assess sensory hypersensitivities, all subjects completed the Allodynia Symptom Checklist-12 (ASC-12), the Photosensitivity Assessment Questionnaire (PAQ), and the Hyperacusis Questionnaire. Differences among groups were assessed using a one-way ANOVA with post-hoc t-tests. Results–Among subject groups, there were differences in gender distribution (PPTH: 34% female; migraine: 77% female; HC: 47% female; p < 0.001) but not age (PPTH: 38.3 ± 10.7 years, migraine: 41.5 ± 10.7 years, and HC: 38.3 ± 9.5 years; p = 0.35). On average, migraine patients had 21.1 ± 5.5 headache days per month, whereas PPTH patients had 16.2 ± 8.2 headache days per month, a significant difference (p < 0.004). Patients with migraine had headache for an average of 24.1 ± 13.7 years, whereas patients with PPTH had headache for an average of 11.2 ± 8.9 years, a significant difference (p < 0.001). PPTH and migraine groups scored higher than HC on all three questionnaires. There were no statistically significant differences between the PPTH and migraine subject groups for cutaneous allodynia or photosensitivity, however; there was a statistically significant difference for phonophobia between migraine and PPTH subject groups (PPTH 22.98 ± 10.41; migraine 15.3 ± 8.82; HC 5.69 ± 4.89; p<0.001). Conclusion–Symptoms of hypersensitivity among individuals with PPTH are equally or more severe than symptoms of hypersensitivity among individuals with migraine. This may suggest that PPTH and migraine may share common pathophysiological changes to neurologic pathways. In addition, insights into the characteristic clinical features of PPTH and their similarity to migraine can be useful when revising diagnostic criteria for PPTH.