Persistent Posttraumatic Headache Is Associated With Reduced Cortical Thickness

MRI of brain
MRI of brain
Investigators sought to determine whether cortical morphology is related to headache frequency, posttraumatic headache, and the number of years with posttraumatic headache.

Compared with healthy controls, patients with persistent posttraumatic headache (PPTH) have less cortical thickness in bilateral frontal regions and right hemisphere parietal regions of the brain, according to results from research published in Headache.

Moreover, for patients with PPTH, greater frequency of headache was related to less thickness in the left and right superior frontal regions, “potentially indicating that brain morphology changes in the superior frontal regions in patients with PPTH are modified by headache frequency,” according to the researchers.

The study was undertaken because posttraumatic headache (PTH) is 1 of the most common symptoms after concussion. When PTH lasts longer than 3 months, it is classified as PPTH. The researchers sought “to investigate differences in cortical thickness in patients with [PPTH] relative to healthy controls and to interrogate whether cortical morphology relates to headache burden (headache frequency, years with [PTH]) in patients with PPTH.”

Their objectives were “to delineate the neuropathology of PPTH, by interrogating differences in cortical thickness in patients with PPTH relative to healthy controls,” and to “interrogate potential associations between brain morphology and headache burden in patients with PPTH by examining whether cortical thickness relates to frequency of headaches or years lived with PTH.”

To investigate these questions, the researchers compared adults with PPTH (n=33; median age, 36.0 years [interquartile range, 20.5 years]) and healthy control patients (n=33; median age, 33.0 years [interquartile range, 15.5 years]) who underwent brain MRI on a 3-Tesla scanner. The researchers determined differences in cortical thickness in patients with PPTH, relative to healthy control patients, using a general linear model design, and explored associations between regional clusters where patients with PPTH showed cortical thickness differences compared with healthy controls with headache frequency and years lived with PPTH.

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Patients with PPTH were found to have less cortical thickness, relative to healthy control patients, in the left and right superior frontal, caudal middle frontal, and precentral cortex, as well as less cortical thickness in the right supramarginal, right superior and inferior parietal, and right precuneus region (P <.05).

There were no regions in which patients with PPTH were found to have increased cortical thickness relative to healthy control patients. Moreover, an analysis of regions that showed less cortical thickness in patients with PPTH demonstrated a negative correlation between left and right superior frontal thickness with headache frequency (P <.05).

Thinner superior frontal cortex in patients with PPTH related to more frequent headaches, “potentially indicating that headache burden modulates cortical thinning in patients with PPTH,” the researchers concluded.


Chong CD, Berisha , Chiang CC, Ross K, Schwedt TJ. Less cortical thickness in patients with persistent post-traumatic headache compared with healthy controls: An MRI study. Headache. 2018; 58(1):53-61.