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Nikolova S, Chong C, Li J, Wu T, Dumkrieger G, Ross K, Starling A, Schwedt TJ. Brain structural and functional abnormalities associated with acute post-traumatic headache: iron deposition and functional connectivity. J Headache Pain 2024; 25:88. [PMID: 38807070 PMCID: PMC11134688 DOI: 10.1186/s10194-024-01797-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/21/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND The purpose of this study was to interrogate brain iron accumulation in participants with acute post-traumatic headache (PTH) due to mild traumatic brain injury (mTBI), and to determine if functional connectivity is affected in areas with iron accumulation. We aimed to examine the correlations between iron accumulation and headache frequency, post-concussion symptom severity, number of mTBIs, and time since most recent TBI. METHODS Sixty participants with acute PTH and 60 age-matched healthy controls (HC) underwent 3T magnetic resonance imaging including quantitative T2* maps and resting-state functional connectivity imaging. Between group T2* differences were determined using T-tests (p < 0.005, cluster size threshold of 90 voxels). For regions with T2* differences, two analyses were conducted. First, the correlations with clinical variables including headache frequency, number of lifetime mTBIs, time since most recent mTBI, and Sport Concussion Assessment Tool (SCAT) symptom severity scale scores were investigated using linear regression. Second, the functional connectivity of these regions with the rest of the brain was examined (significance of p < 0.05 with family wise error correction for multiple comparisons). RESULTS The acute PTH group consisted of 60 participants (22 male, 38 female) with average age of 42 ± 14 years. The HC group consisted of 60 age-matched controls (17 male, 43 female, average age of 42 ± 13). PTH participants had lower T2* values compared to HC in the left posterior cingulate and the bilateral cuneus. Stronger functional connectivity was observed between bilateral cuneus and right cerebellar areas in PTH compared to HC. Within the PTH group, linear regression showed negative associations of T2* in the left posterior cingulate with SCAT symptom severity score (p = 0.05) and T2* in the left cuneus with headache frequency (p = 0.04). CONCLUSIONS Iron accumulation in posterior cingulate and cuneus was observed in those with acute PTH relative to HC; stronger functional connectivity was detected between the bilateral cuneus and the right cerebellum. The correlations of decreased T2* (suggesting higher iron content) with headache frequency and post mTBI symptom severity suggest that the iron accumulation that results from mTBI might reflect the severity of underlying mTBI pathophysiology and associate with post-mTBI symptom severity including PTH.
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Affiliation(s)
- Simona Nikolova
- Department of Neurology, Mayo Clinic, 5777 East Mayo Blvd Phoenix, Phoenix, AZ, 85054, USA
| | - Catherine Chong
- Department of Neurology, Mayo Clinic, 5777 East Mayo Blvd Phoenix, Phoenix, AZ, 85054, USA
- ASU-Mayo Center for Innovative Imaging, Tempe, AZ, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Phoenix, AZ, USA
| | - Jing Li
- School of Industrial and Systems Engineering, Georgia Tech, Georgia, GA, USA
| | - Teresa Wu
- School of Computing, Informatics, Decision Systems Engineering, Arizona State University, Tempe, AZ, USA
- ASU-Mayo Center for Innovative Imaging, Tempe, AZ, USA
| | - Gina Dumkrieger
- Department of Neurology, Mayo Clinic, 5777 East Mayo Blvd Phoenix, Phoenix, AZ, 85054, USA
| | | | - Amaal Starling
- Department of Neurology, Mayo Clinic, 5777 East Mayo Blvd Phoenix, Phoenix, AZ, 85054, USA
| | - Todd J Schwedt
- Department of Neurology, Mayo Clinic, 5777 East Mayo Blvd Phoenix, Phoenix, AZ, 85054, USA.
- ASU-Mayo Center for Innovative Imaging, Tempe, AZ, USA.
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Schwedt TJ. Posttraumatic Headache. Continuum (Minneap Minn) 2024; 30:411-424. [PMID: 38568491 DOI: 10.1212/con.0000000000001410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
OBJECTIVE This article provides an overview of the epidemiology, diagnosis, clinical presentation, pathophysiology, prognosis, and treatment of posttraumatic headache attributed to mild traumatic brain injury (mTBI). LATEST DEVELOPMENTS The International Classification of Headache Disorders, Third Edition requires that posttraumatic headache begin within 7 days of the inciting trauma. Although posttraumatic headache characteristics and associated symptoms vary, most commonly there is substantial overlap with symptoms of migraine or tension-type headache. New insights into posttraumatic headache pathophysiology suggest roles for neuroinflammation, altered pain processing and modulation, and changes in brain structure and function. Although the majority of posttraumatic headache resolves during the acute phase, about one-third of individuals have posttraumatic headache that persists for at least several months. Additional work is needed to identify predictors and early markers of posttraumatic headache persistence, but several potential predictors have been identified such as having migraine prior to the mTBI, the total number of TBIs ever experienced, and the severity of initial symptoms following the mTBI. Few data are available regarding posttraumatic headache treatment; studies investigating different treatments and the optimal timing for initiating posttraumatic headache treatment are needed. ESSENTIAL POINTS Posttraumatic headache begins within 7 days of the causative injury. The characteristics of posttraumatic headache most commonly resemble those of migraine or tension-type headache. Posttraumatic headache persists for 3 months or longer in about one-third of individuals. Additional studies investigating posttraumatic headache treatment are needed.
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Ashina H, Christensen RH, Al-Khazali HM, Iljazi A, Tolnai D, Eigenbrodt AK, Larsson HBW, Schytz HW, Lindberg U, Amin FM. White matter hyperintensities and cerebral microbleeds in persistent post-traumatic headache attributed to mild traumatic brain injury: a magnetic resonance imaging study. J Headache Pain 2023; 24:15. [PMID: 36823546 PMCID: PMC9951434 DOI: 10.1186/s10194-023-01545-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
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.
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Affiliation(s)
- Håkan Ashina
- grid.239395.70000 0000 9011 8547Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA ,grid.475435.4Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark ,grid.475435.4Department of Brain and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Rune H. Christensen
- grid.475435.4Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Haidar Muhsen Al-Khazali
- grid.475435.4Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Afrim Iljazi
- grid.475435.4Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Daniel Tolnai
- grid.5254.60000 0001 0674 042XDepartment of Radiology, Rigshospitalet – Glostrup, Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anna K. Eigenbrodt
- grid.475435.4Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Henrik B. W. Larsson
- grid.5254.60000 0001 0674 042XFunctional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet – Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henrik W. Schytz
- grid.475435.4Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ulrich Lindberg
- grid.5254.60000 0001 0674 042XFunctional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet – Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Faisal Mohammad Amin
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark. .,Department of Brain and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
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Chong CD, Nikolova S, Dumkrieger G, Wu T, Berisha V, Li J, Ross K, Schwedt TJ. Thalamic subfield iron accumulation after acute mild traumatic brain injury as a marker of future post-traumatic headache intensity. Headache 2023; 63:156-164. [PMID: 36651577 PMCID: PMC10184776 DOI: 10.1111/head.14446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To explore alterations in thalamic subfield volume and iron accumulation in individuals with post-traumatic headache (PTH) relative to healthy controls. BACKGROUND The thalamus plays a pivotal role in the pathomechanism of pain and headache, yet the role of the thalamus in PTH attributed to mild traumatic brain injury (mTBI) remains unclear. METHODS A total of 107 participants underwent multimodal T1-weighted and T2* brain magnetic resonance imaging. Using a clinic-based observational study, thalamic subfield volume and thalamic iron accumulation were explored in 52 individuals with acute PTH (mean age = 41.3; standard deviation [SD] = 13.5), imaged on average 24 days post mTBI, and compared to 55 healthy controls (mean age = 38.3; SD = 11.7) without history of mTBI or migraine. Symptoms of mTBI and headache characteristics were assessed at baseline (0-59 days post mTBI) (n = 52) and 3 months later (n = 46) using the Symptom Evaluation of the Sports Concussion Assessment Tool (SCAT-5) and a detailed headache history questionnaire. RESULTS Relative to controls, individuals with acute PTH had significantly less volume in the lateral geniculate nucleus (LGN) (mean volume: PTH = 254.1, SD = 43.4 vs. controls = 278.2, SD = 39.8; p = 0.003) as well as more iron deposition in the left LGN (PTH: T2* signal = 38.6, SD = 6.5 vs. controls: T2* signal = 45.3, SD = 2.3; p = 0.048). Correlations in individuals with PTH revealed a positive relationship between left LGN T2* iron deposition and SCAT-5 symptom severity score at baseline (r = -0.29, p = 0.019) and maximum headache intensity at the 3-month follow-up (r = -0.47, p = 0.002). CONCLUSION Relative to healthy controls, individuals with acute PTH had less volume and higher iron deposition in the left LGN. Higher iron deposition in the left LGN might reflect mTBI severity and poor headache recovery.
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Affiliation(s)
- Catherine D Chong
- Department of Neurology, Mayo Clinic, Phoenix, Arizona, USA.,ASU-Mayo Center for Innovative Imaging, Phoenix, Arizona, USA
| | | | | | - Teresa Wu
- ASU-Mayo Center for Innovative Imaging, Phoenix, Arizona, USA.,School of Computing and Augmented Intelligence, Arizona State University, Tempe, Arizona, USA
| | - Visar Berisha
- ASU-Mayo Center for Innovative Imaging, Phoenix, Arizona, USA.,School of Electrical, Computer and Energy Engineering and College of Health Solutions, Arizona State University, Tempe, Arizona, USA.,College of Health Solutions, Arizona State University, Tempe, Arizona, USA
| | - Jing Li
- School of Industrial and Systems Engineering, Georgia Tech, Atlanta, Georgia, USA
| | | | - Todd J Schwedt
- Department of Neurology, Mayo Clinic, Phoenix, Arizona, USA.,ASU-Mayo Center for Innovative Imaging, Phoenix, Arizona, USA
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Jia YJ, Li QS. Ferroptosis: a critical player and potential therapeutic target in traumatic brain injury and spinal cord injury. Neural Regen Res 2023; 18:506-512. [DOI: 10.4103/1673-5374.350187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Atogepant (Qulipta™) is an orally administered, small-molecule, calcitonin gene-related peptide (CGRP) receptor antagonist being developed by AbbVie for the prophylaxis of migraine. In September 2021, atogepant was approved in the USA for the preventive treatment of episodic migraine in adults. The drug is also in phase 3 clinical development for the preventive treatment of migraine in various other countries. This article summarizes the milestones in the development of atogepant leading to this first approval for the preventive treatment of episodic migraine in adults.
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Affiliation(s)
- Emma D Deeks
- Springer Nature, Mairangi Bay, Private Bag 65901, Auckland, 0754, New Zealand.
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