The following article is part of conference coverage from the 2018 American Headache Society Annual Scientific Meeting in San Francisco, California. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AHS 2018.

SAN FRANCISCO — According to a study presented by Ann Scher, PhD, of the Uniformed Services University at the 60th Annual Scientific Meeting of the American Headache Society, recently deployed soldiers with posttraumatic headache (PTH) related to a traumatic brain injury (TBI) tend to have more severe and frequent migrainous headaches following concussion.

“There are limited data on the phenotypic differences between headaches related to mild TBI (mTBI) and ‘regular’ headaches,” Dr Scher and colleagues wrote. “The objective of the present study is to compare headache features and 1-year prognosis in a cohort of recently deployed soldiers with and without a recent history of a deployment-related mild TBI.”

Soldiers based at Fort Bragg and Fort Carson who recently returned from deployment in Iraq or Afghanistan were recruited for analysis (N=1567). Soldiers had either a mTBI or were free from TBI at time of enrollment. At baseline, as well as 3 months and 12 months following recruitment, participants were provided a headache questionnaire to evaluate headache symptoms.

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The investigators assessed participants for photophobia, unilateral location, phonophobia, exacerbation, nausea, pulsatility, sensory aura, pain level and frequency, visual aura, and allodynia features. Participants with mTBI who had headaches that began or worsened following a head injury were characterized as having mTBI +PTH, whereas other cases were defined as being mTBI -PTH.

At baseline, the majority of mTBI cases (80%) as well as controls (64%) reported experiencing headaches within the past year. A significantly greater proportion of patients with mTBI +PTH reported experiencing daily or continuous headaches compared with controls and those with mTBI -PTH (24% vs 5% and 7%, respectively; P <.001). Each headache and migraine feature assessed at baseline and during the 12-month study period were significantly higher among mTBI +PTH cases compared with mTBI -PTH cases (P <.05). Controls and mTBI -PTH cases reported a similar number of headache and migraine features, aside from headache frequency and sensory aura.

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While mean annualized headache frequency was reduced by approximately 20 days at 3 months and 12 months in the mTBI +PTH group, the burden remained greater in this group compared with those in the -PTH group. Baseline evaluations of visual or sensory aura or pulsatility were associated with reduced headache frequency at 12 months, while baseline headache pain was a negative prognostic factor.

“Better understanding of the PTH phenotype will inform the design of interventional studies for this difficult to treat population,” the researchers concluded.

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Scher A, Metti A, Schwab K, et al. Post-traumatic vs non-traumatic headaches: a phenotypic analysis. Presented at: 2018 American Headache Society Annual Scientific Meeting. June 28-July 1, 2018; San Francisco, CA. Abstract 449618.