White matter hyperintensities and cerebral microbleeds in persistent post-traumatic headache attributed to mild traumatic brain injury: a magnetic resonance imaging study

• Published in: Journal of headache and pain Vol. 24; no. 1; p. 15
• Main Authors: Ashina, Håkan, Christensen, Rune H., Al-Khazali, Haidar Muhsen, Iljazi, Afrim, Tolnai, Daniel, Eigenbrodt, Anna K., Larsson, Henrik B. W., Schytz, Henrik W., Lindberg, Ulrich, Amin, Faisal Mohammad
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 24.02.2023; Springer Nature B.V; BMC
• Subjects: Adult; Brain Concussion - complications; Brain Concussion - diagnostic imaging; Cerebral Hemorrhage - complications; Cerebral Hemorrhage - diagnostic imaging; Cerebral Hemorrhage - pathology; Comorbidity; Concussion; Gender; Head Trauma; Headache; Headaches; Humans; Internal Medicine; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Medicine; Medicine & Public Health; Migraine; Neuroimage on Headache; Neuroimaging; Neurology; Pain Medicine; Pathophysiology; Post-Traumatic Headache - pathology; Substantia alba; Traumatic brain injury; White Matter - pathology; Neuroimaging; Concussion; Head Trauma; Pathophysiology; Migraine
• ISSN: 1129-2377; 1129-2369; 1129-2377
• DOI: 10.1186/s10194-023-01545-w

Objective To examine whether white matter hyperintensities (WMHs) and cerebral microbleeds (CMBs) are more prevalent in people with persistent post-traumatic headache attributed to mild traumatic brain injury (TBI), compared with healthy controls. Methods A magnetic resonance imaging (MRI) study of adults with persistent post-traumatic headache attributed to mild TBI and age- and gender-matched healthy controls. A semi-structured interview and validated self-report instruments were used to record data on demographics, clinical characteristics, and comorbidities. Imaging data were obtained on a 3T MRI Scanner using a 32-channel head coil. Participants and controls underwent a single MRI session, in which fluid-attenuated inversion recovery was used to visualize WMHs, and susceptibility-weighted imaging was used to detect CMBs. The primary outcomes were (I) the difference in the mean number of WMHs between participants with persistent post-traumatic headache and healthy controls and (II) the difference in the mean number of CMBs between participants with persistent post-traumatic headache and healthy controls. All images were examined by a certified neuroradiologist who was blinded to the group status of the participants and controls. Results A total of 97 participants with persistent post-traumatic headache and 96 age- and gender-matched healthy controls provided imaging data eligible for analyses. Among 97 participants with persistent post-traumatic headache, 43 (44.3%) participants presented with ≥ 1 WMH, and 3 (3.1%) participants presented with ≥ 1 CMB. Compared with controls, no differences were found in the mean number of WMHs (2.7 vs. 2.1, P  = 0.58) and the mean number of CMBs (0.03 vs. 0.04, P  = 0.98). Conclusions WMHs and CMBs were not more prevalent in people with persistent post-traumatic headache than observed in healthy controls. Future studies should focus on other MRI techniques to identify radiologic biomarkers of post-traumatic headache.