Research Reports - Persistent post-traumatic headache vs. migraine: an MRI study demonstrating differences in brain structure

J Headache Pain. 2017 Aug 22;18(1):87. doi: 10.1186/s10194-017-0796-0.

Schwedt TJ(1), Chong CD(2)(3), Peplinski J(3), Ross K(4), Berisha V(3).

BACKGROUND: The majority of individuals with post-traumatic headache have
symptoms that are indistinguishable from migraine. The overlap in symptoms
amongst these individuals raises the question as to whether post-traumatic
headache has a unique pathophysiology or if head trauma triggers migraine. The
objective of this study was to compare brain structure in individuals with
persistent post-traumatic headache (i.e. headache lasting at least 3 months
following a traumatic brain injury) attributed to mild traumatic brain injury to
that of individuals with migraine.
METHODS: Twenty-eight individuals with persistent post-traumatic headache
attributed to mild traumatic brain injury and 28 individuals with migraine
underwent brain magnetic resonance imaging on a 3 T scanner. Regional volumes,
cortical thickness, surface area and curvature measurements were calculated from
T1-weighted sequences and compared between subject groups using ANCOVA. MRI data
from 28 healthy control subjects were used to interpret the differences in brain
structure between migraine and persistent post-traumatic headache.
RESULTS: Differences in regional volumes, cortical thickness, surface area and
brain curvature were identified when comparing the group of individuals with
persistent post-traumatic headache to the group with migraine. Structure was
different between groups for regions within the right lateral orbitofrontal lobe,
left caudal middle frontal lobe, left superior frontal lobe, left precuneus and
right supramarginal gyrus (p < .05). Considering these regions only, there were
differences between individuals with persistent post-traumatic headache and
healthy controls within the right lateral orbitofrontal lobe, right supramarginal
gyrus, and left superior frontal lobe and no differences when comparing the
migraine cohort to healthy controls.
CONCLUSIONS: In conclusion, persistent post-traumatic headache and migraine are
associated with differences in brain structure, perhaps suggesting differences in
their underlying pathophysiology. Additional studies are needed to further
delineate similarities and differences in brain structure and function that are
associated with post-traumatic headache and migraine and to determine their
specificity for each of the headache types. 

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