A History of Mild Traumatic Brain Injury Is Associated With a a More Severe Long-term Migraine Phenotype

Objective This study aimed to investigate the effect of prior mTBI on the clinical features and disability in patients presenting with migraine. Background Head injury is a risk factor for chronic migraine (CM) and migraine is a risk factor for persistent headache after mild traumatic brain injury (mTBI). Design/Methods Of 2,161 migraine patients without a diagnosis of post-traumatic headache (PTH) who participated in the American Registry for Migraine Research (ARMR) between February 2016 and March 2020, 1,120 answered questions about a history of mTBI. After controlling for age, gender, and having CM, demographics, headache characteristics, Patient Health Questionnaire-2 (PHQ-2) score, General Anxiety Disorder-7 (GAD-7) grade, and Migraine Disability Assessment Scale (MIDAS) scores were compared between those with a history of mTBI to those without. Results Among 1,098 migraine patients, 37.6% (n = 413) had a history of mTBI. The patients with mTBI were more likely to have CM (p = 0.004), dizziness (p = 0.003), vertigo (p = 0.009), and difficulty finding words (p < 0.001). Patients with mTBI had significantly greater scores on the MIDAS (58.6 +/- 52.6 vs 50.0 +/- 47.8, p = 0.034) and PHQ-2 (1.6 +/- 1.8 vs 1.3 +/- 1.6, p = 0.012), and had significantly higher proportion of moderate to severe GAD-7 grade (21.7% vs 17.1%, p = 0.017) compared to those without mTBI. Conclusions In patients presenting with migraine, a prior history of mTBI was associated with a diagnosis of chronic migraine, disability, anxiety and depression severity, as well as dizziness, vertigo, and word finding difficulty. A history of mTBI should be assessed in patients presenting with migraine, and people with migraine who have a high exposure risk to mTBI, should be aware of the potential for migraine progression and psychiatric symptoms after mTBI.