Evaluation of Posttraumatic Headache Phenotype and Recovery Time After Youth Concussion

• Published in: JAMA network open 2021-03, Vol.4 (3), p.e211312-e211312
• Main Authors: Kamins, Joshua, Richards, Rachel, Barney, Bradley J, Locandro, Christopher, Pacchia, Christina F, Charles, Andrew C, Cook, Lawrence J, Gioia, Gerard, Giza, Christopher C, Blume, Heidi K
• Format: Article
• Language: English
• Subjects: Concussion; Genotype & phenotype; Headaches; Migraine; Neurology; Online Only; Original Investigation; Traumatic brain injury
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2021.1312

The Four Corners Youth Consortium was created to fill the gap in our understanding of youth concussion. This study is the first analysis of posttraumatic headache (PTH) phenotype and prognosis in this cohort of concussed youth. To describe the characteristics of youth with PTH and determine whether the PTH phenotype is associated with outcome. This cohort study examined outcomes from patients in a multi-institutional registry of traumatic brain injury (TBI) clinics from December 2017 to June 2019. Inclusion criteria included being between ages 5 and 18 years at enrollment and presentation within 8 weeks of a mild TBI. Data were analyzed between February 2019 and January 2021. Mild TBI with standard care. Time to recovery and headache 3 months after injury; measurement device is the Postconcussion Symptom Inventory (PCSI). PTH with migraine phenotype was defined as moderate-severe headache that is new or significantly worse compared with baseline and associated with nausea and/or photophobia and phonophobia. A total of 612 patients with 625 concussions were enrolled, of whom 387 patients with 395 concussions consented to participate in this study. One hundred nine concussions were excluded (concussions, rather than patients, were the unit of analysis), leaving 281 participants with 286 concussions (168 [58.7%] girls; 195 [75.6%] White; 238 [83.2%] aged 13-18 years). At the initial visit, 133 concussions (46.5%) were from patients experiencing PTH with a migraine phenotype, 57 (20%) were from patients experiencing PTH with a nonmigraine phenotype, and 96 (34%) were from patients with no PTH. Patients with any PTH after concussion were more likely to have prolonged recovery than those without PTH (median [interquartile range], 89 [48-165] days vs 44 [26-96] days; log-rank P