Migraine history predicted concussion severity, data from the prospective, longitudinal Toronto Concussion Study showed.
Concussion patients with a pre-injury accident lifetime history of migraine had significantly more concussion symptoms (P<0.001) and (P<0.001) on the Sports Concussion Assessment Tool () than people without migraine history, reported Laura Langer, MSc, of the Toronto Rehabilitation Institute of University Health Network, and colleagues.
Concussion symptoms and severity scores were higher among people who had pre-injury migraines more frequently than once a month, and remained elevated throughout the 16-week study, they said in a presentation at the American Headache Society virtual meeting.
"This study is one of the few studies that have linked symptomatic recovery to pre-injury baselines," Langer told MedPage Today.
"This information is important for physicians treating patients with a concussion and pre-concussion history of migraine," she added. "It may flag that a patient is at risk for a prolonged recovery, which could influence treatment plan -- lifestyle modifications, appropriate pharmacological treatment considerations, etc. -- especially if the migraines were more than one per month before injury."
How concussion treatment might change for frequent migraineurs isn't clear. "Recognizing that a pre-concussion history of migraines more than once monthly may place individuals at increased risk for greater number, greater intensity, and longer-lasting concussion-related symptoms suggests that this subgroup of patients may be a population worthy of evaluation to determine whether treatment with the new CGRP monoclonal antibodies may result in meaningfully improved recovery trajectory," co-author Jonathan Gladstone, MD, also of the Toronto Rehabilitation Institute, told MedPage Today.
The Toronto Concussion Study enrolled patients within 7 days of head injury and concussion diagnosis from local referring emergency departments. Patients with workplace or motor vehicle accidents or anyone potentially seeking injury compensation were excluded, as were people with moderate to severe injury.
A total of 302 concussion patients completed questionnaires about history of migraine and headache before injury. Of these, 116 (38.1%) reported a pre-injury history of migraine. Most (75%) migraineurs were female and mean age was 33. Similar to people without migraine history, 92% of migraine patients reported headache at week 1.
Participants also completed questionnaires about concussion symptoms and severity weekly during the first 8 weeks, then at week 12 and week 16.
At baseline, 27 people had migraines that were more frequent than monthly. These people had more symptoms (P=0.027) and a greater symptom severity (P=0.001) than people who had pre-accident migraines on a less frequent basis. In week 1, 42% of the group with more-than-monthly baseline migraines said they had "continuous" post-traumatic headaches, compared with 16% of other patients (P=0.04).
This group also trended toward slower recovery: "22% of migraineurs with more than one migraine a month before their concussion still had not recovered to their pre-concussion baseline at week 16," Langer noted.
Findings were limited by small sample size; only 27 participants had migraines more frequently than monthly. "Further analysis of the migraine cohort is needed to identify any mediating factors for increased concussion symptom severity and prolonged recovery that may be present, such as sex, pre-injury mental health, injury coping strategies, or sleep quality," Langer added.
Disclosures
Researchers disclosed relevant relationships with Novartis, Allergan, Amgen, Aralez, Eli Lilly, and Teva.
Primary Source
American Headache Association
Langer L, et al "Effects of Pre-Injury Migraine Frequency on Post-Traumatic Headache Recovery in the General Adult Population: The Toronto Concussion Study" AHS 2020.