Effects of Pre-injury Migraine Frequency on Post-traumatic Headache Recovery in the General Adult Population: The Toronto Concussion Study

Laura K. Langer, MSc

AHSAM 2020 - Oral session
Published on July 23, 2020 

3 minute listen

7 minute read

Key messages

  • A history of migraine can cause a greater number and severity of symptoms following a concussion.
  • A migraine frequency of at least once a month prior to a concussion can lead to a slower recovery.
  • Background

    What do we already know about this topic?
  • Findings

    What does this study add?
  • Perspectives

    How does this study impact clinical practice?
  • Expert commentary

    by Nada Hindiyeh, MD

Key messages

  • A history of migraine can cause a greater number and severity of symptoms following a concussion.
  • A migraine frequency of at least once a month prior to a concussion can lead to a slower recovery.

Background

What do we already know about this topic?

  • Pre-accident migraine history may be a risk factor, following a concussion, for the development of acute post-traumatic headache (PTH), persistent PTH and persistent post-concussion symptoms.1,2
  • Recently published data from the Toronto Concussion Study suggested pre-concussion migraine history was associated with a greater number and severity of post-concussion symptoms 1–12 weeks post-injury and headache persistence 12 and 16 weeks post-accident.3
  • Previous PTH research has typically focused upon specific populations, several months to years following injury, while the effect of pre-injury migraine frequency has not been well studied.

How was this study conducted?

  • A prospective longitudinal 16-week study of adults (n=302) aged 17–85 years diagnosed with concussion within 7 days of injury, excluding workplace and vehicle injuries.
  • A standardized headache questionnaire was completed within 7 days of injury for ascertaining headache history, followed by a weekly Baseline Headache Questionnaire and SCAT 5 (Sport  Concussion Assessment Tool) testing with intermittent physician assessments.

Findings

What does this study add?

  • Individuals with a pre-accident history of migraine had more frequent and more severe, concussion symptoms than those with no pre-accident migraine history throughout the 12 weeks following injury.
  • Individuals with a history of migraine had a higher rate of headache endorsement attributed to their concussion at week 12 than those with no history of migraine.
  • Within the migraine subgroups, there was no difference between symptom number, severity or headaches attributed to concussion between those with infrequent migraines or no migraine during the year before the injury.
  • Those with a high occurrence of migraine in the year prior had more frequent or more severe concussion symptoms than the other groups and demonstrated a trend towards higher rates of endorsement of headaches attributing to their concussion (statistically insignificant due to the small sample size).

Perspectives

How does this study impact clinical practice?

  • Post-concussion recovery for patients with a history of migraine (particularly if migraines were more frequent than monthly) will include a greater number and severity of symptoms up to 12 weeks after injury, suggesting patients should be monitored and/or their treatment adjusted during this time.
  • For the majority of patients, headache frequency will return to their previous pre-injury levels 12 weeks post-concussion.
  • A larger cohort of people with more frequent pre-injury migraine is required for further analysis.

Perspectives

How does this study impact clinical practice?

  • Post-concussion recovery for patients with a history of migraine (particularly if migraines were more frequent than monthly) will include a greater number and severity of symptoms up to 12 weeks after injury, suggesting patients should be monitored and/or their treatment adjusted during this time.
  • For the majority of patients, headache frequency will return to their previous pre-injury levels 12 weeks post-concussion.
  • A larger cohort of people with more frequent pre-injury migraine is required for further analysis.

This is a highlights summary of an oral session given at the AHSAM 2020 Virtual Annual Scientific Meeting and presented by:

Laura K. Langer, MSc (Biostats, Can.)
Toronto Rehabilitation Institute - University Health Network
Toronto, Ontario, Canada

The content is produced by Infomedica, the official reporting partner of ASHAM 2020 Virtual Annual Scientific Meeting. The summary text was drafted by Goldcrest Medical Writing, reviewed by Marco Vercellino, MD, an independent external expert, and approved by Jessica Ailani, MD, FAHS and Mark J. Burish, MD, PhD, the scientific editors of the program.

The presenting authors of the original session had no part in the creation of this conference highlights summary.

In addition, an expert commentary on the topic has been provided by:

Nada Hindiyeh, MD
Stanford University Medical Center

Nada Hindiyeh, MD
Stanford University Medical Center

Nada Hindiyeh, M.D., is a board certified Neurologist and headache specialist and is currently a Clinical Assistant Professor in the department of Neurology at Stanford University. She is the Director of Clinical Research for the Stanford division of Headache Medicine and serves as principal investigator for several clinical trials.

She was awarded the 2013 Clinical Research Fellowship in Neurotoxins by the American Academy of Neurology and under this scholarship is currently investigating a diagnostic screening protocol for chronic migraine. Other research interests include pathophysiology and novel treatments for migraine, the use of transcranial magnetic stimulation in headache disorders, and participation in clinical trials for new headache therapeutics. She is currently a member of the American Headache Society (AHS), serves on the AHS Electronic Media committee and was chosen as an AHS Emerging Leader in the field in 2017. She is also a member of the International Headache Society.

Dr. Hindiyeh completed her medical degree at the University of Toledo College of Medicine in Toledo Ohio. Both her internship and neurology residency were completed at the University of California, Irvine, Medical Center, where she was chief resident. She completed her fellowship in headache and facial pain at Stanford University School of Medicine.

1. Riechers RG 2nd, Walker MF, Ruff RL. Post-traumatic headaches. Handb Clin Neurol 2015;128:567-578.

2. ND Silverberg, GL Iverson. Etiology of the post-concussion syndrome: physiogenesis and psychogenesis revisited. Neuro Rehabilitation 2011;29:317-329.

3. Langer L, Bayley M, Lawrence D, et al. Effects of Pre-Accident History of Migraine on Acute Concussion Symptoms and Recovery: The Toronto Concussion Study. American Academy of Neurology Annual (virtual) Meeting 2020, Toronto Canada, April 25–May 1, 2020.



Headache
Post-traumatic Headache


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