Evaluation of Posttraumatic Headache Phenotype and Recovery Time After Youth Concussion.
Evaluation of Posttraumatic Headache Phenotype and Recovery Time After Youth Concussion.
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DOI：
10.1001/jamanetworkopen.2021.1312
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发表时间：
2021-03-01
影响因子：
13.8
通讯作者：
Blume HK
中科院分区：
文献类型：
--
作者：
Kamins J;Richards R;Barney BJ;Locandro C;Pacchia CF;Charles AC;Cook LJ;Gioia G;Giza CC;Blume HK
青年脑震荡后创伤后头痛（PTH）的结果与偏头痛表型相关吗？在这项来自四角青年联盟的队列研究中，包括281例患者（286例脑震荡），与非偏头痛PTH表型或无PTH相比，偏头痛PTH表型与脑震荡后恢复时间延长和持续性PTH风险较高相关。这些研究结果表明，PTH与偏头痛表型可能是一个标志物，更显着的损伤或有害的病理生理损伤后，头部受伤，并可能是一个目标，早期干预，以防止持续性和致残性脑震荡后的症状。这项队列研究的青年经历创伤后头痛脑震荡检查偏头痛表型和恢复结果之间的关系。四角青年联盟的成立是为了填补我们对青年脑震荡理解的差距。本研究是首次分析脑震荡青少年的创伤后头痛（PTH）表型和预后。描述青年甲状旁腺激素患者的特征，并确定甲状旁腺激素表型是否与预后相关。这项队列研究检查了2017年12月至2019年6月期间创伤性脑损伤（TBI）诊所多机构登记处患者的结局。入选标准包括入组时年龄在5至18岁之间，并在轻度TBI的8周内就诊。分析了2019年2月至2021年1月期间的数据。轻度创伤性脑损伤标准治疗。受伤后3个月恢复和头痛的时间;测量设备是脑震荡后症状量表（PCSI）。PTH伴偏头痛表型定义为中重度头痛，新发或与基线相比显著恶化，并伴有恶心和/或恐惧症和声音恐惧症。共有612例患者（625例脑震荡）入组，其中387例患者（395例脑震荡）同意参加本研究。排除了109例脑震荡（脑震荡，而不是患者，是分析的单位），留下281名参与者，286例脑震荡（168 [58.7%]女孩; 195 [75.6%]白色; 238 [83.2%]年龄13-18岁）。在初次就诊时，133例脑震荡（46.5%）来自患有偏头痛表型的PTH患者，57例（20%）来自患有非偏头痛表型的PTH患者，96例（34%）来自无PTH患者。脑震荡后有任何甲状旁腺激素的患者比没有甲状旁腺激素的患者更可能有延长的恢复时间（中位数[四分位数范围]，89 [48-165]天vs 44 [26-96]天;对数秩P < .001）。患有甲状旁腺激素和偏头痛表型的患者比非偏头痛表型的患者需要更长的时间恢复（中位数[四分位数间距]，95 [54-195]天vs 70 [46-119]天;对数秩P = 0.01）。在每种表型中，3个月时的恢复或PTH在性别之间没有显著差异。与非偏头痛PTH或无PTH相比，具有偏头痛表型的PTH与脑震荡后的持续症状相关。鉴于女性与偏头痛和偏头痛PTH的发生率较高相关，我们的发现可能是对先前研究中发现的一种解释，即女孩比男孩具有更高的持续脑震荡后症状的风险。
Are outcomes for posttraumatic headache (PTH) after youth concussion associated with migraine phenotype? In this cohort study from the Four Corners Youth Consortium including 281 patients with 286 concussions, PTH with migraine phenotype was associated with prolonged recovery and higher risk of persistent PTH following concussion compared with nonmigraine PTH phenotype or no PTH. These findings suggest that PTH with migraine phenotype may be a marker for more significant injury or deleterious pathophysiology after head injury and could be a target for early intervention to prevent persistent and disabling symptoms following concussion. This cohort study of youth experiencing posttraumatic headache following concussion examines the association between migraine phenotype and recovery outcomes. 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. 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.
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DOI：
10.1177/1740774512438980
发表时间：
2012-06
期刊：
Clinical trials (London, England)
影响因子：
--
作者：
Grinnon ST;Miller K;Marler JR;Lu Y;Stout A;Odenkirchen J;Kunitz S
通讯作者：
Kunitz S
影响因子：
8
作者：
Blume, Heidi K.;Vavilala, Monica S.;Rivara, Frederick P.
通讯作者：
Rivara, Frederick P.
影响因子：
9.9
作者：
Oskoui, Maryam;Pringsheim, Tamara;Hershey, Andrew D.
通讯作者：
Hershey, Andrew D.
影响因子：
1.9
作者：
Pearson, Rachel;Levyim, Desiree;Langdon, Raquel
通讯作者：
Langdon, Raquel
影响因子：
2.6
作者：
Brooks, Brian L.;Kadoura, Basil;Barlow, Karen M.
通讯作者：
Barlow, Karen M.