Post-traumatic headache phenotypic characteristics and treatment utilization

Background: Post-traumatic headache (PTH) is typically described as migraine- or tension-type-like and treated based on presentation. However, the actual presentations of PTH are not well characterized. The aim of this study is to provide a phenotypic characterization of persistent PTH and co-occurring neurological symptoms from a previously completed clinical trial and characterize PTH treatment utilization.
Methods: This study is a secondary analysis of veterans (N=193) recruited to participate in a randomized clinical trial of cognitive-behavioral therapy, cognitive processing therapy, or treatment as usual for PTH. Descriptive statistics were examined across characteristics of PTH, including age, gender, neurobehavioral symptoms, headache-related disability, pain characteristics, pain locations, accompanying symptoms, and aura symptoms and treatment utilization.
Results: The median presentation of PTH in this study was a headache with severe pain, lasting about 4 h, and with about 13 headache episodes per month. About half the participants reported a pulsating quality and/or nausea that accompanied head pain. Most characteristics were uncorrelated to each other. The majority of participants used medication to treat persistent PTH. Neurostimulation was the most common non-pharmacological treatment.
Conclusions: The results of this study show that characteristics associated with migraine are more frequently reported with PTH. Correlations among the migraine characteristics were moderate overall, and there was notable variability among reported characteristics of PTH. Treatment utilization for PTH was not associated with current neurobehavioral symptoms and included both pharmacological and non-pharmacological options.