Migraine History Pre-Concussion Linked to Worse Symptoms Post-Injury

Results from The Toronto Concussion Study, presented virtually at the 2020 American Headache Society (AHS) Annual Meeting, suggests that individuals who sustained a concussion and have a pre-injury history of migraine, especially if the pre-accident attacks of migraine were more frequent than monthly, have a worse post-concussion recovery.

Among the 302 participants who filled out a Headache Questionnaire at Week 1, 116 (38,1%) of them reported a pre-injury history of migraine in their lifetime. Among migraineurs, 84% had experienced at least 1 migraine in the past year and 92% of individuals reported a migraine at Week 1.

Data showed that those with pre-accident lifetime history of migraine had significantly higher Sports Concussion Assessment Tool (SCAT-3) symptom score (16.9; standard deviation [SD], 4.7; P <.001) and symptom severity score (52.3; SD, 26.1; P <.001) scores than those without prior migraine at Week 1.

The research, which was presented by Laura Langer, BSc, research analysist, Toronto Rehabilitation Institute, revealed that the elevated SCAT-3 scores remained consistent through all 16 weeks of the trial (P <.001). Those who experienced pre-accident migraines that occurred more frequent than monthly (n = 27) had notably higher scores on the SCAT-3 (61.8; SD, 26.5; P = .001) and experienced more symptoms (18.1; SD, 4.5; P = .027) compared with those pre-accident migraines less than monthly at Week 1. Those scores were maintained across all weeks assessed (P <.001).

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At Week 1, among those with pre-accident migraines that were more frequent than monthly, 42% endorsed “continuous” post-traumatic headache (PTH) compared to 18% of those with pre-accident migraines that were less frequent than monthly (P = .04). Langer and colleagues concluded that these differences did not reach statistical significance.

“When stratified according to pre-accident migraine frequency, the recovery trajectory of headache following concussion improves for all groups over the 16 weeks followed. The group with migraines at least once monthly pre-concussion had a trend towards slower recovery than those with less frequent pre-injury migraines,” the authors wrote.

Demographically, the study included 75% of patients who reported a pre-injury history of migraine in their lifetime were female, and the mean age was 33.3 years (Standard Deviation [SD], 12.1). Migraineurs were evaluated for frequency of migraines in the year prior to concussion. Langer and colleagues found that 46% experienced migraine every few months, 16% did not in the past year, 14% had migraines once per month, 10% had twice per month, 8% had them 2—3 times per week, and 6% experienced them once per week. It was noted in the presentation that no patients had headaches >15 days per month in the year pre-concussion.

The naturalist prospective cohort design aimed to find the influence of pre-accident history of migraine following a concussion in a general adult population. Those included in the study would be evaluated in a university-based emergency department within 7 days of diagnosed with a concussion. None of the patients included in the study had concussions that were claim related, such as workplace accidents or motor vehicle collisions.

Each patient completed a standardized headache questionnaire following their concussion that evaluated pre-accident headache. They were then followed for 16 weeks and completed weekly SCAT-3 assessments and headache questionnaires.

Researchers concluded that not only does having pre-injury history of migraine have an impact on post-concussion trajectory, but the frequency of attacks compared to monthly can directly increase the number and severity of post-concussion symptoms.

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REFERENCE

Langer LK, Bayley MT, Lawrence DW, et al. Effects of pre-injury migraine frequency on post-traumatic headache recovery in the general adult population: the Toronto Concussion study. Headache. 2020;60(S1 suppl). 1—156. doi: 10.1111/head.13854.