Post-Traumatic Headache With Migraine Phenotype Associated With Prolonged Recovery After Concussion

child with concussion being examined, bruise on head
Sport boy’s temple with a bruise
Study authors described the characteristics of youth with post-traumatic headache and determined whether the PTH phenotype was associated with outcome.

Young patients with post-traumatic headache following concussion experienced a longer recovery than patients without post-traumatic headache after injury, according to results from a study published in JAMA Network Open.

In this cohort study, a team of researchers examined outcomes of 612 children and adolescents from traumatic brain injury (TBI) clinics from 2017 to 2019. All patients had presented within an 8-week period of a mild TBI. The main outcomes of interest included time to recovery and headache that occurred approximately 3 months after injury. The outcomes were measured using the Post-Concussion Symptom Inventory.

Overall, there were 625 concussions recorded in the study patients. A total of 281 patients with 286 concussions fulfilled the inclusion criteria, agreed to participate in the study, and were included in the final analysis.

Approximately 46.5% (n=133) of concussions at the initial visit were from patients who had post-traumatic headache with a migraine phenotype. A post-traumatic headache with a migraine phenotype was defined in this study “as moderate to severe headache that is new or significantly worse compared with baseline” and is associated with nausea and/or photophobia and phonophobia. In the cohort, 20% (n=57) of concussions were from patients with post-traumatic headache with nonmigraine phenotype, whereas 34% (n=96) of concussions were from patients with no post-traumatic headache.

Compared with patients without post-traumatic headache, those with post-traumatic headache following concussion had a significantly longer recovery (median, 89 vs 44 days, respectively; P <.001). Additionally, those with post-traumatic headache and a migraine phenotype had a significantly longer recovery time compared with patients with nonmigraine phenotype (median, 95 vs 70 days, respectively; P =.01).

Limitations of this study were the inclusion of a higher proportion of girls (58.7%) and patients of more advanced age (13-18 years of age, 83.2%), factors which have been historically associated with prolonged post-concussion recovery.

Based on their findings, the investigators concluded that post-traumatic headache “with a migraine phenotype may indicate a more deleterious pathophysiology following concussion, which leads to a higher risk of persistent symptoms and could be a target for early intervention following concussion.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Kamins J, Richards R, Barney BJ, et al. Evaluation of posttraumatic headache phenotype and recovery time after youth concussion. JAMA Netw Open. 2021;4(3):e211312. doi:10.1001/jamanetworkopen.2021.1312