Klein Susan K, Brown Cynthia B, Ostrowski-Delahanty Sarah, Bruckman David, Victorio M Cristina
Neurology, NDSC, 1079Akron Children's Hospital, Akron, OH, USA.
2569Cleveland Clinic Foundation, Cleveland, OH, USA.
J Child Neurol. 2022 Jun 3:8830738221100327. doi: 10.1177/08830738221100327.
The primary aim of this study is to develop an easy way to identify migraine phenotype posttraumatic headache (MPTH) in children with traumatic brain injury, to treat headache in traumatic brain injury effectively, and to promote faster recovery from traumatic brain injury symptoms overall. We evaluated youth aged 7-20 years in a pediatric neurology traumatic brain injury (TBI) clinic, assigning a migraine phenotype for post-traumatic headache (MPTH) at the initial visit with the 3-item ID Migraine Screener. We stratified the sample by early (≤6 weeks) and late (>6 weeks) presenters, using days to recovery from concussion symptoms as the primary outcome variable. 397 youth were assessed; 54% were female. Median age was 15.1 years (range 7.0-20.4 years), and 34% of the sample had sports-related injuries. Migraine phenotype for posttraumatic headache (MPTH) was assigned to 56.1% of those seen within 6 weeks of traumatic brain injury and 50.7% of those seen after the 6-week mark. Irrespective of whether they were early or late presenters to our clinic, patients with migraine phenotype (MPTH) took longer to recover from traumatic brain injury than those with posttraumatic headache (PTH) alone. Log rank test indicated that the survival (ie, recovery) distributions between those with migraine phenotype posttraumatic headache (MPTH) and those with posttraumatic headache (PTH) were statistically different, χ2(3) = 50.186 ( < .001). Early identification of migraine phenotype posttraumatic headache (MPTH) following concussion can help guide more effective treatment of headache in traumatic brain injury and provide a road map for the trajectory of recovery from traumatic brain injury symptoms. It will also help us understand better the mechanisms that underlie conversion to persistent posttraumatic headache and chronic migraine after traumatic brain injury.
本研究的主要目的是开发一种简便方法，用于识别创伤性脑损伤儿童的偏头痛型创伤后头痛（MPTH），有效治疗创伤性脑损伤后的头痛，并总体上促进从创伤性脑损伤症状中更快恢复。我们在儿科神经科创伤性脑损伤（TBI）诊所对7至20岁的青少年进行了评估，在初次就诊时使用3项ID偏头痛筛查器为创伤后头痛（MPTH）指定偏头痛型。我们将样本按早期（≤6周）和晚期（>6周）就诊者进行分层，将从脑震荡症状恢复的天数作为主要结局变量。共评估了397名青少年；54%为女性。中位年龄为15.1岁（范围7.0 - 20.4岁），34%的样本有与运动相关的损伤。创伤性脑损伤后6周内就诊者中56.1%被指定为偏头痛型创伤后头痛（MPTH），6周后就诊者中50.7%被指定为此类型。无论他们是早期还是晚期到我们诊所就诊，偏头痛型（MPTH）患者从创伤性脑损伤中恢复的时间都比单纯创伤后头痛（PTH）患者更长。对数秩检验表明，偏头痛型创伤后头痛（MPTH）患者和创伤后头痛（PTH）患者的生存（即恢复）分布在统计学上存在差异，χ2(3) = 50.186（P <.001）。脑震荡后早期识别偏头痛型创伤后头痛（MPTH）有助于指导更有效地治疗创伤性脑损伤后的头痛，并为从创伤性脑损伤症状恢复的轨迹提供路线图。这也将有助于我们更好地理解创伤性脑损伤后转变为持续性创伤后头痛和慢性偏头痛的潜在机制。
