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

Author(s):

Patients with pre-concussion migraines that occurred at a rate of >1 per month had a greater number of concussion symptoms and burden over 12 weeks.

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).

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.