Background & Aims
Headache after mild head trauma is a common clinical picture that can lead to post-concussion syndrome (PCS) which consists of a cluster of symptoms such as headache, concentration problems, anxiety, irritability, insomnia, blurred vision, tinnitus, sensitivity to noise, dizziness, and fatigue (1–3). The treatment of PCS is symptom-based and there is lack of evidence-based treatment options specific to PCS (4). Since 2010, Onabotulinumtoxin A (BoNT-A) has been approved for chronic migraines (5), and there is some evidence indicating that BoNT-A can potentially improve chronic daily headaches (6). Therefore, we want to investigate if BoNT-A can be a treatment option for certain patients with persistent headache after a mild head trauma.
Methods
We conducted a retrospective quality assurance study at the Department of Neurology, Aalborg University Hospital investigating patients from the period 2016-2021 with persistent headache after mild head trauma lasting more than 3 months after the concussion treated with BoNT-A injections in the neck muscles. The medical records were screened for accompanying symptoms, number over treatment sessions and treatment effect: We defined a positive treatment effect as 3 or more repetitive BoNT-A treatments. The secondary outcome was to look for patterns of accompanying symptoms that could predict positive or negative treatment effects.
Results
282 patients have been treated with BoNT-A between 2016 and 2021 at the headache clinic AAUH. 19 of these patients had a history of headache following a mild head trauma. 11 out of 19 (57,9%) had a positive effect defined by 3 or more BoNT-A treatments. 4/19 fulfilled both the International Classification of Diseases, Tenth Revision (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for PCS, and all 4 had positive effect. 4/19 fulfilled only the ICD-10 criteria with only one patient responding positive to BoNT-A treatment. 6/11 responders did neither fulfill ICD-10 nor DSM-IV criteria.
Conclusions
Our results show that BoNT-A injections in neck muscles can serve as a potential treatment option in managing chronic daily headache among patients with persistent headache after mild head trauma. Furthermore, we found that patients fulfilling both ICD-10 and DSM-4 criteria had the highest chance to benefit from the BoNT-A injection treatment. But further placebo controlled double, blinded randomized clinical trials are needed to confirm our findings and improve patient selection criteria.
References
1. Boake C, McCauley SR, Levin HS, Pedroza C, Contant CF, Song JX, et al. Diagnostic criteria for postconcussional syndrome after mild to moderate traumatic brain injury. J Neuropsychiatry Clin Neurosci. 2005;17(3):350–6.
2. Olesen J. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211.
3. Lucas S, Hoffman JM, Bell KR, Dikmen S. A prospective study of prevalence and characterization of headache following mild traumatic brain injury. Cephalalgia. 2014;34(2):93–102.
4. Kim K, Priefer R. Evaluation of current post-concussion protocols. Biomed Pharmacother. 2020 Sep;129:110406.
5. Corasaniti MT, Bagetta G, Nicotera P, Tarsitano A, Tonin P, Sandrini G, et al. Safety of Onabotulinumtoxin A in Chronic Migraine: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Toxins (Basel). 2023 May;15(5).
6. Porta M, Camerlingo M. Headache and botulinum toxin. J Headache Pain. 2005;6(4):325–7.
Presenting Author
Kübra Kilic
Poster Authors
Topics
- Specific Pain Conditions/Pain in Specific Populations: Headache