Symptoms of Autonomic Dysfunction Among Those With Persistent Posttraumatic Headache Attributed to Mild Traumatic Brain Injury: A Comparison to Migraine and Healthy Controls

• Published in: Headache 2018-10, Vol.58 (9), p.1397-1407
• Main Authors: Howard, Levi, Dumkrieger, Gina, Chong, Catherine D., Ross, Katherine, Berisha, Visar, Schwedt, Todd J.
• Format: Article
• Language: English
• Subjects: autonomic dysfunction; Bladder; Brain; Diagnostic systems; Domains; Dysautonomia; Head injuries; Headache; Headaches; Health risk assessment; Health risks; Intolerance; Migraine; orthostatic intolerance; Patients; Phenotypes; posttraumatic headache; Questionnaires; Traumatic brain injury
• ISSN: 0017-8748; 1526-4610
• DOI: 10.1111/head.13396

Background Most persistent posttraumatic headaches (PPTH) have a phenotype that meets diagnostic criteria for migraine or probable migraine. Although symptoms of autonomic dysfunction have been well described among those with migraine, the presence and relative severity of such symptoms among those with PPTH have yet to be reported. Objective The objective of this study was to assess and compare symptoms of autonomic dysfunction among those with PPTH attributed to mild traumatic brain injury (mTBI) vs migraine vs healthy controls using Composite Autonomic Symptom Score 31 (COMPASS‐31) questionnaire scores. Methods Individuals with PPTH (n = 56) (87.5% of whom had a migraine/probable migraine phenotype), migraine (n = 30), and healthy controls (n = 36) were prospectively assessed in this cross‐sectional cohort study using the COMPASS‐31 questionnaire. Total COMPASS‐31 scores and individual domain scores (bladder, gastrointestinal, orthostatic intolerance, pupillomotor, secretomotor, vasomotor) were compared between subject groups. Results COMPASS‐31 mean total weighted score was 37.22 ± 15.44 in the PPTH group, 27.15 ± 14.37 in the migraine group, and 11.67 ± 8.98 for healthy controls. COMPASS‐31 mean weighted total scores were significantly higher in those with PPTH vs migraine (P = .014), for PPTH vs healthy controls (P = .001), and for migraine vs healthy controls (P = .001). Those with PPTH had numerically higher scores for all COMPASS‐31 domains compared to those with migraine, and the domain scores were significantly higher for orthostatic intolerance (PPTH = 4.80 ± 2.47 vs migraine = 3.33 ± 2.31, P = .027) and bladder (PPTH = 1.14 ± 1.45 vs migraine = 0.47 ± 0.73, P = .020). Among individuals with PPTH, post hoc correlations indicated a positive association between number of total lifetime TBIs with total weighted COMPASS‐31 scores (rho = 0.32, P = .020), between years lived with headache and vasomotor domain subscores (rho = 0.27; P = .044), and between headache frequency with vasomotor domain subscores (rho = 0.27; P = .041). Conclusions Symptoms of autonomic dysfunction were greatest among those with PPTH compared to migraine and healthy controls. Among individuals with PPTH, number of lifetime TBIs was associated with greater symptoms of autonomic dysfunction, while greater headache burden was associated with higher vasomotor domain autonomic dysfunction subscores, potentially indicating that PPTH patients with higher disease burden have an incre