Post-traumatic headache with a migraine phenotype associated with prolonged recovery from a concussion

Young patients with post-traumatic headache after a concussion recovered longer than patients without post-traumatic headache after an injury, according to a study published on JAMA Network Open.

In this cohort study, a team of researchers examined the results of 612 children and adolescents from clinics for traumatic brain injury (TBI) from 2017 to 2019. All patients presented with a mild TBI within a period of 8 weeks. Key findings of interest included time to recovery and headaches that occurred approximately 3 months after injury. The results were measured using the post-concussion symptom inventory.

A total of 625 concussions were found in the study patients. A total of 281 patients with 286 concussions met the inclusion criteria, agreed to participate in the study, and were included in the final analysis.

Approximately 46.5% (n = 133) of the concussions on the first visit were from patients with post-traumatic headache with the migraine phenotype. A post-traumatic headache with a migraine phenotype was defined in this study as “moderate to severe headache that is new or significantly worse than the baseline value” and associated with nausea and / or photophobia and phonophobia. In the cohort, 20% (n = 57) of the concussions came from patients with post-traumatic headache with a non-migraine phenotype, while 34% (n = 96) of the concussions came from patients without post-traumatic headache.

Compared to patients without post-traumatic headache, patients with post-traumatic headache recovered significantly longer after a concussion (median 89 versus 44 days; P <0.001). In addition, patients with post-traumatic headache and migraine phenotype had a significantly longer recovery time than patients with non-migraine phenotype (median 95 vs. 70 days; P = 0.01).

Limitations of this study were the inclusion of a higher proportion of girls (58.7%) and patients of advanced age (13-18 years old, 83.2%), factors that have historically been associated with prolonged recovery from a concussion.

Based on their results, the researchers concluded that post-traumatic headache “with a migraine phenotype may indicate a more damaging post-concussion pathophysiology, leading to a higher risk of persistent symptoms and be a target for early intervention after a concussion could.”

Disclosure: Several authors of the study have stated that they are part of the pharmaceutical industry. See the original reference for a full list of what the authors said.


Kamins J., Richards R., Barney BJ, et al. Assessment of post-traumatic headache phenotype and recovery time after concussion in adolescents. JAMA Netw Open. 2021; 4 (3): e211312. doi: 10.1001 / jamanetworkopen.2021.1312

This article originally appeared on Clinical Pain Advisor

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