How headache and headache type after concussion could indicate longer recovery time


Headache following concussion is not unusual, but could the type help indicate which cases may be prolonged?

Concussion and mild traumatic brain injury can be a fact of life for many children, due in part to active play outside and organized team sports. Most cases will resolve in a few days or weeks, but some children may have long-term outcomes because of concussion. Posttraumatic headaches are a common symptom of concussion, and headaches with migraine phenotype have been noted to sometimes indicate longer recovery times. A report in JAMA Network Open examines how posttraumatic headache phenotype might be linked to outcomes.1

Investigators from the Four Corner Youth Consortium looked at the outcomes of patients included in a registry of traumatic brain injury clinics from December 2017 to June 2019. To be included in the cohort study, children had to be aged between 5 and 18 years and present within 8 weeks of mild traumatic brain injury. Investigators used the Postconcussion Symptom Inventory for measurement. Posttraumatic headache with a migraine phenotype was considered a moderate-severe headache that was either new or significantly worse than baseline. It also included nausea and/or photophobia and phonophobia.

A total of 281 patients with 286 concussions were included in the study. Most of the participants were aged 13 to 18 years and White. During the initial visit, 133 concussions were from children who were experiencing a posttraumatic headache with a migraine phenotype; 57 were patients experiencing posttraumatic headache with a nonmigraine phenotype; and 96 of the concussions occurred in patients with no posttraumatic headache. Patients with any form of posttraumatic headache following concussion were found to be more likely to have a prolonged recovery period than the patients who had no posttraumatic headache (median [interquartile range], 89 [48-165] days vs 44 [26-96] days; log-rank P < .001). Among the patients with posttraumatic headache, those who had a migraine phenotype were found to take significantly longer to recover than the patients who had a nonmigraine phenotype (median [interquartile range], 95 [54-195] days vs 70 [46-119] days; log-rank P = .01). No significant difference in recovery or posttraumatic headache at 3 months was noted between the sexes within each headache phenotype.

The investigators concluded that posttraumatic headaches with migraine following concussion were linked to persistent symptoms, when compared to posttraumatic headaches without migraines or no posttraumatic headache at all. When a patient presents with posttraumatic headaches with a phenotype, the findings indicate that early and swift intervention could help improve recovery time and outcomes. The investigators urged for further research that validates the headache phenotypes seen in posttraumatic concussion as well as more study of the outcomes.


1. Kamins J, Richards R, Barney B. Evaluation of posttraumatic headache phenotype and recovery time after youth concussion. JAMA Netw Open. 2021;4(3):e211312. doi:10.1001/jamanetworkopen.2021.1312

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