Migraine phenotype prolongs recovery time in traumatic brain injury (TBI)

We proposed that children and adolescents who had headache of migraine phenotype at initial neurologic assessment after mild TBI would take longer to clear for return to play than those who did not have those headache characteristics. Additionally, we predicted that those with migraine phenotype would be more likely to have comorbid mood or cognitive symptoms, which would also contribute to prolonged recovery. To test this, we assessed all new patients for the presence or absence of migraine phenotype with the Three-Item ID migraine screener (Lipton et al. 2003) at the first outpatient visit. Over the 5 months follow up interval (October 2017–February 2018), office visit data for 121 patients (ages 0–19 years) showed that 61% presented initially with a migraine phenotype. In that interval, 48% % (N = 58) were cleared for return to play. Those with migraine phenotype headache took longer to clear (99 vs 71 days respectively, p = 0.004). Neither age nor gender made a significant impact on length of recovery when only the presence or absence of migraine phenotype alone was considered. If patients had a migraine (vs non-migraine) phenotype headache and comorbid cognitive or behavioral symptoms (38% in our sample), their time to recovery was prolonged (109 vs 74 days respectively; F (1, 56) = 7.215, p = 0.009). These data suggest that early identification of migraine phenotype in assessment of post-traumatic headache can lead to aggressive treatment of headache, thus shortening the interval of disability after TBI. Cognitive and behavioral symptoms seem to have additional impact on recovery and should be addressed and supported in rehabilitation.