Persistent post-traumatic headache attributed to mild traumatic brain injury: Deep phenotyping and treatment patterns
Persistent post-traumatic headache attributed to mild traumatic brain injury: Deep phenotyping and treatment patterns
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DOI：
10.1177/0333102420909865
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发表时间：
2020-02-26
期刊：
影响因子：
4.9
通讯作者：
Winther Schytz, Henrik
中科院分区：
文献类型：
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作者：
Ashina, Hakan;Iljazi, Afrim;Winther Schytz, Henrik
目的探讨轻度外伤性脑损伤所致持续性创伤后头痛的临床特点及治疗方法。方法2018年7月至2019年6月，共纳入100例轻度外伤性脑损伤所致持续性创伤后头痛患者。使用半结构化访谈进行深度表型分析，同时使用12项异位性疼痛症状检查表评估异位性疼痛。结果100例持续性创伤后头痛患者，平均头痛频次为25.4±7.1天/月。最常见的头痛表型是慢性偏头痛样头痛（n = 61），其次是发作性偏头痛样头痛和紧张性头痛（n = 29），而9名受试者报告“纯粹”慢性紧张性头痛。最常见的诱发因素是压力、睡眠不足和强光。63名受试者报告了预防用药史，其中79%报告至少一种预防用药失败，19%报告至少四种预防用药失败。54%的受试者没有皮肤异常性疼痛，23%为轻度，17%为中度，6%为重度。结论持续性创伤后头痛患者的头痛特征通常类似于慢性偏头痛样表型或发作性偏头痛样和紧张性头痛样组合表型。据报道，针对偏头痛的预防药物大多无效。因此，迫切需要病理生理学的见解和疾病特异性治疗。
ObjectiveTo investigate clinical characteristics and treatment patterns in persistent post-traumatic headache attributed to mild traumatic brain injury.MethodsA total of 100 individuals with persistent post-traumatic headache attributed to mild traumatic brain injury were enrolled between July 2018 and June 2019. Deep phenotyping was performed using a semi-structured interview while allodynia was assessed using the 12-item Allodynia Symptom Checklist.ResultsIn 100 subjects with persistent post-traumatic headache, the mean headache frequency was 25.4 +/- 7.1 days per month. The most common headache phenotype was chronic migraine-like headache (n = 61) followed by combined episodic migraine-like and tension-type-like headache (n = 29) while nine subjects reported "pure" chronic tension-type-like headache. The most frequent trigger factors were stress, lack of sleep, and bright lights. A history of preventive medication use was reported by 63 subjects, of which 79% reported failure of at least one preventive drug, while 19% reported failure of at least four preventive drugs. Cutaneous allodynia was absent in 54% of the subjects, mild in 23%, moderate in 17%, and severe in 6%.ConclusionsThe headache profile of individuals with persistent post-traumatic headache most often resembled a chronic migraine-like phenotype or a combined episodic migraine-like and tension-type-like headache phenotype. Migraine-specific preventive medications were largely reported to be ineffective. Therefore, there is a pressing need for pathophysiological insights and disease-specific therapies.