Goldberg Migraine Program, Department of Neurology, David Geffen School of Medicine at University of California, Los Angeles.
UCLA Steve Tisch BrainSPORT Program, Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles.
JAMA Netw Open. 2021 Mar 1;4(3):e211312. doi: 10.1001/jamanetworkopen.2021.1312.
The Four Corners Youth Consortium was created to fill the gap in our understanding of youth concussion. This study is the first analysis of posttraumatic headache (PTH) phenotype and prognosis in this cohort of concussed youth.
To describe the characteristics of youth with PTH and determine whether the PTH phenotype is associated with outcome.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study examined outcomes from patients in a multi-institutional registry of traumatic brain injury (TBI) clinics from December 2017 to June 2019. Inclusion criteria included being between ages 5 and 18 years at enrollment and presentation within 8 weeks of a mild TBI. Data were analyzed between February 2019 and January 2021.
Mild TBI with standard care.
Time to recovery and headache 3 months after injury; measurement device is the Postconcussion Symptom Inventory (PCSI). PTH with migraine phenotype was defined as moderate-severe headache that is new or significantly worse compared with baseline and associated with nausea and/or photophobia and phonophobia.
A total of 612 patients with 625 concussions were enrolled, of whom 387 patients with 395 concussions consented to participate in this study. One hundred nine concussions were excluded (concussions, rather than patients, were the unit of analysis), leaving 281 participants with 286 concussions (168 [58.7%] girls; 195 [75.6%] White; 238 [83.2%] aged 13-18 years). At the initial visit, 133 concussions (46.5%) were from patients experiencing PTH with a migraine phenotype, 57 (20%) were from patients experiencing PTH with a nonmigraine phenotype, and 96 (34%) were from patients with no PTH. Patients with any PTH after concussion were more likely to have prolonged recovery than those without PTH (median [interquartile range], 89 [48-165] days vs 44 [26-96] days; log-rank P < .001). Patients with PTH and a migraine phenotype took significantly longer to recover than those with nonmigraine phenotype (median [interquartile range], 95 [54-195] days vs 70 [46-119] days; log-rank P = .01). Within each phenotype, there was no significant difference between sexes in recovery or PTH at 3 months.
PTH with a migraine phenotype is associated with persistent symptoms following concussion compared with nonmigraine PTH or no PTH. Given that female sex is associated with higher rates of migraine and migraine PTH, our finding may be one explanation for findings in prior studies that girls are at higher risk for persistent postconcussion symptoms than boys.
四角青年联合会的成立是为了填补我们对青少年脑震荡认识的空白。本研究是对该脑震荡青少年队列中创伤后头痛（PTH）表型和预后的首次分析。
描述患有 PTH 的青少年的特征，并确定 PTH 表型是否与结局相关。
设计、地点和参与者：本队列研究检查了 2017 年 12 月至 2019 年 6 月期间来自多个创伤性脑损伤（TBI）诊所的多机构登记处的患者的结局。纳入标准包括入组时年龄在 5 至 18 岁之间，以及在轻度 TBI 后 8 周内就诊。数据分析于 2019 年 2 月至 2021 年 1 月进行。
轻度 TBI 伴标准治疗。
受伤后 3 个月的恢复时间和头痛；测量仪器为创伤后症状问卷（PCSI）。偏头痛表型的 PTH 定义为与基线相比新出现或明显恶化的中度至重度头痛，伴有恶心和/或畏光和恐声。
共纳入 612 名患有 625 次脑震荡的患者，其中 387 名患者有 395 次脑震荡同意参与本研究。排除了 109 例脑震荡（以脑震荡而非患者作为分析单位），最终 281 名参与者有 286 例脑震荡（168 [58.7%] 为女孩；195 [75.6%] 为白人；238 [83.2%] 为 13-18 岁）。在初次就诊时，133 例脑震荡（46.5%）患者患有偏头痛表型的 PTH，57 例（20%）患者患有非偏头痛表型的 PTH，96 例（34%）患者患有非 PTH。与无 PTH 的患者相比，患有任何 PTH 的脑震荡患者恢复时间更长（中位数[四分位距]，89 [48-165] 天与 44 [26-96] 天；对数秩 P <.001）。患有偏头痛表型 PTH 的患者比患有非偏头痛表型 PTH 的患者恢复时间明显更长（中位数[四分位距]，95 [54-195] 天与 70 [46-119] 天；对数秩 P =.01）。在每个表型中，性别在 3 个月时的恢复或 PTH 方面没有显著差异。
与非偏头痛 PTH 或无 PTH 相比，偏头痛表型的 PTH 与脑震荡后持续症状相关。鉴于女性偏头痛和偏头痛 PTH 的发生率较高，我们的发现可能是先前研究中发现女孩比男孩更容易出现持续性脑震荡后症状的原因之一。
