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Jessen J, Höffken O, Schwenkreis P, Tegenthoff M, Özgül ÖS, Enax-Krumova E. Posttraumatic headache: pain related evoked potentials (PREP) and conditioned pain modulation (CPM) to assess the pain modulatory function. Sci Rep 2024; 14:16306. [PMID: 39009744 PMCID: PMC11251016 DOI: 10.1038/s41598-024-67288-z] [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: 03/11/2024] [Accepted: 07/09/2024] [Indexed: 07/17/2024] Open
Abstract
Posttraumatic headache (PTH) is common following traumatic brain injury and impacts quality of life. We investigated descending pain modulation as one possible mechanism for PTH and correlated it to clinical measures. Pain-related evoked potentials (PREP) were recorded in 26 PTH-patients and 20 controls after electrical stimulation at the right hand and forehead with concentric surface electrodes. Conditioned pain modulation (CPM) was assessed using painful cutaneous electric stimulation (PCES) on the right hand as test stimulus and immersion of the left hand into 10 °C-cold water bath as conditioning stimulus based on changes in pain intensity and in amplitudes of PCES-evoked potentials. All participants completed questionnaires assessing depression, anxiety, and pain catastrophising. PTH-patients reported significantly higher pain ratings during PREP-recording in both areas despite similar stimulus intensity at pain threshold. N1P1-amplitudes during PREP and CPM-assessment were lower in patients in both areas, but statistically significant only on the hand. Both, PREP-N1-latencies and CPM-effects (based on the N1P1-amplitudes and pain ratings) were similar in both groups. Patients showed significantly higher ratings for anxiety and depression, which did not correlate with the CPM-effect. Our results indicate generalized hyperalgesia for electrical stimuli in both hand and face in PTH. The lacking correlation between pain ratings and EEG parameters indicates different mechanisms of pain perception and nociception.
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Affiliation(s)
- Julia Jessen
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Oliver Höffken
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Peter Schwenkreis
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Martin Tegenthoff
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Özüm Simal Özgül
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Elena Enax-Krumova
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
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Mavroudis I, Chatzikonstantinou S, Petridis F, Balmus IM, Ciobica A. A review of the personality traits in post-concussion syndrome. Acta Neurol Belg 2024; 124:791-802. [PMID: 38194159 DOI: 10.1007/s13760-023-02466-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/18/2023] [Indexed: 01/10/2024]
Abstract
INTRODUCTION Various manifestations ranging from physical symptoms to cognitive and emotional impairments could often be seen following head concussions that lead to mild traumatic brain injury (mTBI). These symptoms are commonly comprising the post-concussion syndrome (PCS) and their resolution could be influenced by multiple factors. Personality traits have been suggested as potential risk factors for the emergence and persistence of PCS. In this study, we aimed to investigate the possible predisposition to PCS given by certain personality traits. METHODS Prospective cohort studies, observational studies, and cross-phenotype polygenic risk score analyses were selected from the main scientific databases (PubMed/Medline, Scopus, EMBASE, Web of Science) based on multiple-step screening, using keywords (such as "personality traits", "post-concussion syndrome", "traumatic brain injury", "anxiety", "depression", "resilience", and "somatization") and inclusion/exclusion criteria (English written studies available in full text presenting relevant data on TBI patients and their personality traits; reviews, animal studies, and studies not written in English, not available in full text, or not presenting full demographical and clinical data were excluded). The investigated personality traits included emotional reserve, somatic trait anxiety, embitterment, mistrust, parental anxiety, state anxiety, trait anxiety, anxiety sensitivity, pain catastrophizing, helplessness, sports-concussion symptom load, and cognitive resilience. RESULTS The reviewed data from 16 selected studies suggested that personality traits play an essential role in the development and persistence of PCS. Emotional reserve, cognitive resilience, and lower levels of somatic trait anxiety were associated with better outcomes in PCS. However, higher levels of anxiety sensitivity, pain catastrophizing, helplessness, and sports-concussion symptom load were associated with worse outcomes in PCS. Parental anxiety was not associated with persistent symptoms in children following concussion. Despite the statistical analysis regarding the included publications bias was low, further studies should further investigate the correlation between TBI and some personality traits, as some of the selected studies did not included healthy individuals and their psychological profiles for comparison and correlation analysis. CONCLUSION Personality traits may help predict the development and persistence of PCS following mTBI. Understanding the personality traits roles in PCS could assist the development of targeted interventions for the prevention and treatment of PCS. Further research is needed to better understand the complex interactions between personality traits, neurobiological factors, and psychosocial factors in PCS.
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Affiliation(s)
- Ioannis Mavroudis
- Department of Neuroscience, Leeds Teaching Hospitals, NHS Trust, Leeds, LS9 7TF, UK
- Leeds University, Leeds, LS2 9JT, UK
| | | | - Foivos Petridis
- Third Department of Neurology, Aristotle University of Thessaloniki, 541 24, Thessaloniki, Greece
| | - Ioana-Miruna Balmus
- Department of Exact Sciences and Natural Sciences, Institute of Interdisciplinary Research, "Alexandru Ioan Cuza" University of Iasi, Alexandru Lapusneanu Street, No. 26, 700057, Iasi, Romania.
| | - Alin Ciobica
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University of Iasi, 20th Carol I Avenue, 700506, Iași, Romania
- Centre of Biomedical Research, Romanian Academy, B dul Carol I, No. 8, 700506, Iasi, Romania
- Academy of Romanian Scientists, Splaiul Independentei Nr. 54, Sector 5, 050094, Bucharest, Romania
- Preclinical Department, Apollonia University, 11, Pacurari, Iasi, Romania
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Rushendran R, Singh A, Ankul Singh S, Chitra V, Ilango K. A role of NLRP3 and MMP9 in migraine progression: a systematic review of translational study. Front Neurol 2024; 15:1307319. [PMID: 38836002 PMCID: PMC11148868 DOI: 10.3389/fneur.2024.1307319] [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: 10/04/2023] [Accepted: 04/24/2024] [Indexed: 06/06/2024] Open
Abstract
Background Migraines affect one billion individuals globally, with a higher occurrence among young adults and women. A significant survey in the United States indicated that 17.1% of women and 5.6% of men suffer from migraines. This study seeks to investigate the potential connection between NLRP3 and MMP9 in migraine pathology. Methods The research involved searching databases such as PubMed, Scopus, Science Direct, Google Scholar, and Proquest, with the search concluding on March 31, 2024. Following PRISMA guidelines, PICO data were collected, focusing exclusively on animal models induced by Nitroglycerine (10 mg/kg), while excluding clinical studies. Results The study, originally registered in Prospero Reg. No. CRD42022355893, conducted bias analysis using SYRCLE's RoB tool and evaluated author consensus using GraphPad v9.5.1. Out of 7,359 search results, 22 papers met the inclusion criteria. Inter-rater reliability among reviewers was assessed using Cohen's kappa statistics. Conclusion This review summarizes 22 preclinical studies on Nitroglycerin (NTG), NLRP3, MMP9, and related biomarkers in migraine. They reveal that NTG, especially at 10 mg/kg, consistently induces migraine-like symptoms in rodents by activating NLRP3 inflammasome and stimulating proinflammatory molecule production. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, CRD42022355893.
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Affiliation(s)
- Rapuru Rushendran
- Department of Pharmacology, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu, Chennai, India
| | - Anuragh Singh
- Department of Pharmacology, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu, Chennai, India
| | - S Ankul Singh
- Department of Pharmacology, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu, Chennai, India
| | - Vellapandian Chitra
- Department of Pharmacology, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu, Chennai, India
| | - Kaliappan Ilango
- Department of Pharmaceutical Chemistry, Tagore College of Pharmacy, Chennai, India
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Rothka AJ, Jonik S, Nelsen J, Patel S, Cherin N. A case of SIADH following uncomplicated mild traumatic brain injury: Did cognitive bias delay treatment? Clin Case Rep 2024; 12:e8874. [PMID: 38725933 PMCID: PMC11079531 DOI: 10.1002/ccr3.8874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/11/2024] [Accepted: 04/21/2024] [Indexed: 05/12/2024] Open
Abstract
To optimize clinical care, it is imperative for providers to recognize their own inherent cognitive biases and the impact that has on their clinical decision making, thereby minimizing complications such as prolonged hospitalization, unnecessary healthcare spending, and impaired patient satisfaction and functional outcomes.
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Affiliation(s)
| | | | - Jacob Nelsen
- Penn State College of MedicineHersheyPennsylvaniaUSA
| | - Shivani Patel
- Penn State Health Department of Physical Medicine and RehabilitationPenn State Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Neyha Cherin
- Penn State Health Department of Physical Medicine and RehabilitationPenn State Hershey Medical CenterHersheyPennsylvaniaUSA
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Ahmed Z, Chaudhary F, Fraix MP, Agrawal DK. Epidemiology, Pathophysiology, and Treatment Strategies of Concussions: A Comprehensive Review. FORTUNE JOURNAL OF HEALTH SCIENCES 2024; 7:197-215. [PMID: 38708028 PMCID: PMC11067689 DOI: 10.26502/fjhs.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
A concussion is a particular manifestation of a traumatic brain injury, which is the leading cause of mortality and disabilities across the globe. The global prevalence of traumatic brain injury is estimated to be 939 instances per 100,000 individuals, with approximately 5.48 million people per year experiencing severe traumatic brain injury. Epidemiology varies amongst different countries by socioeconomic status with diverse clinical manifestations. Additionally, classifying concussions is an ambiguous process as clinical diagnoses are the only current classification method, and morbidity rates differ by demographic location as well as populations examined. In this article, we critically reviewed the pathophysiology of concussions, classification methods, treatment options available including both pharmacologic and nonpharmacologic intervention methods, etiologies as well as global etiologic differences associated with them, and clinical manifestations along with their associated morbidities. Furthermore, analysis of the current research regarding the incidence of concussion based traumatic brain injuries and future directions are discussed. Investigation on the efficacy of new therapeutic-related interventions such as exosome therapy and electromagnetic field stimulation are warranted to properly manage and treat concussion-induced traumatic brain injury.
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Affiliation(s)
- Zubair Ahmed
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona CA 91766
| | - Fihr Chaudhary
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona CA 91766
| | - Marcel P Fraix
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona CA 91766
| | - Devendra K Agrawal
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona CA 91766
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Howe EI, Andelic N, Brunborg C, Zeldovich M, Helseth E, Skandsen T, Olsen A, Fure SCR, Theadom A, Rauen K, Madsen BÅ, Jacobs B, van der Naalt J, Tartaglia MC, Einarsen CE, Storvig G, Tronvik E, Tverdal C, von Steinbüchel N, Røe C, Hellstrøm T. Frequency and predictors of headache in the first 12 months after traumatic brain injury: results from CENTER-TBI. J Headache Pain 2024; 25:44. [PMID: 38528477 DOI: 10.1186/s10194-024-01751-0] [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: 02/16/2024] [Accepted: 03/15/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Headache is a prevalent and debilitating symptom following traumatic brain injury (TBI). Large-scale, prospective cohort studies are needed to establish long-term headache prevalence and associated factors after TBI. This study aimed to assess the frequency and severity of headache after TBI and determine whether sociodemographic factors, injury severity characteristics, and pre- and post-injury comorbidities predicted changes in headache frequency and severity during the first 12 months after injury. METHODS A large patient sample from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) prospective observational cohort study was used. Patients were stratified based on their clinical care pathway: admitted to an emergency room (ER), a ward (ADM) or an intensive care unit (ICU) in the acute phase. Headache was assessed using a single item from the Rivermead Post-Concussion Symptoms Questionnaire measured at baseline, 3, 6 and 12 months after injury. Mixed-effect logistic regression analyses were applied to investigate changes in headache frequency and associated predictors. RESULTS A total of 2,291 patients responded to the headache item at baseline. At study enrolment, 59.3% of patients reported acute headache, with similar frequencies across all strata. Female patients and those aged up to 40 years reported a higher frequency of headache at baseline compared to males and older adults. The frequency of severe headache was highest in patients admitted to the ICU. The frequency of headache in the ER stratum decreased substantially from baseline to 3 months and remained from 3 to 6 months. Similar trajectory trends were observed in the ICU and ADM strata across 12 months. Younger age, more severe TBI, fatigue, neck pain and vision problems were among the predictors of more severe headache over time. More than 25% of patients experienced headache at 12 months after injury. CONCLUSIONS Headache is a common symptom after TBI, especially in female and younger patients. It typically decreases in the first 3 months before stabilising. However, more than a quarter of patients still experienced headache at 12 months after injury. Translational research is needed to advance the clinical decision-making process and improve targeted medical treatment for headache. TRIAL REGISTRATION ClinicalTrials.gov NCT02210221.
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Affiliation(s)
- Emilie Isager Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.
- Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Marina Zeldovich
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Eirik Helseth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway
| | - Toril Skandsen
- Department of Neuromedicine and Movement Science, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- NorHEAD - Norwegian Centre for Headache Research, Trondheim, Norway
| | - Alexander Olsen
- Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- NorHEAD - Norwegian Centre for Headache Research, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Silje C R Fure
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Alice Theadom
- TBI Network, Department of Psychology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Katrin Rauen
- Neurological Rehabilitation Center Godeshöhe, Bonn, Germany
- Department of Traumatology & Department of Psychiatry, Psychotherapy, and Psychosomatics, Neuroscience Center Zurich, University of Zurich, University Hospital Zurich, Zürich, Switzerland
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Benedikte Å Madsen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bram Jacobs
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joukje van der Naalt
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
- Canadian Concussion Centre, Krembil Brain Institute, Toronto, ON, Canada
- Memory Clinic, Toronto Western Hospital, Toronto, ON, Canada
| | - Cathrine Elisabeth Einarsen
- Department of Neuromedicine and Movement Science, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Gøril Storvig
- Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- NorHEAD - Norwegian Centre for Headache Research, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erling Tronvik
- NorHEAD - Norwegian Centre for Headache Research, Trondheim, Norway
- Department of Neurology, St. Olav University Hospital, Trondheim, Norway
| | - Cathrine Tverdal
- Department of Neurosurgery, Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway
| | | | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Torgeir Hellstrøm
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
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da Silva Fiorin F, do Espírito Santo CC, Da Silva JT, Chung MK. Inflammation, brain connectivity, and neuromodulation in post-traumatic headache. Brain Behav Immun Health 2024; 35:100723. [PMID: 38292321 PMCID: PMC10827408 DOI: 10.1016/j.bbih.2024.100723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 02/01/2024] Open
Abstract
Post-traumatic headache (PTH) is a debilitating condition that affects individuals with different levels of traumatic brain injury (TBI) severity. The difficulties in developing an effective treatment are related to a lack of understanding the complicated mechanisms and neurobiological changes in brain function after a brain injury. Preclinical studies have indicated that peripheral and central sensitization of the trigeminal nociceptive pathways contributes to PTH. While recent brain imaging studies have uncovered widespread changes in brain functional connectivity following trauma, understanding exactly how these networks contribute to PTH after injury remains unknown. Stimulation of peripheral (trigeminal or vagus) nerves show promising efficacies in PTH experimental animals, likely mediated by influencing TBI-induced pathological plasticity by decreasing neuroinflammation and neuronal apoptosis. Non-invasive brain stimulations, such as transcranial magnetic or direct current stimulations, show analgesia for multiple chronic pain conditions, including PTH. Better mechanistic understanding of analgesia achieved by neuromodulations can define peripheral and central mechanisms involved in the development, the resolution, and the management of PTH.
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Affiliation(s)
- Fernando da Silva Fiorin
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Program in Neuroscience, Center to Advance Chronic Pain Research, Baltimore, MD, USA
| | - Caroline Cunha do Espírito Santo
- Graduate Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Brazil
| | - Joyce T. Da Silva
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Program in Neuroscience, Center to Advance Chronic Pain Research, Baltimore, MD, USA
| | - Man-Kyo Chung
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Program in Neuroscience, Center to Advance Chronic Pain Research, Baltimore, MD, USA
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O’Connell CJ, Brown RS, Peach TM, Traubert OD, Schwierling HC, Notorgiacomo GA, Robson MJ. Strain in the Midbrain: Impact of Traumatic Brain Injury on the Central Serotonin System. Brain Sci 2024; 14:51. [PMID: 38248266 PMCID: PMC10813794 DOI: 10.3390/brainsci14010051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/20/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
Traumatic brain injury (TBI) is a pervasive public health crisis that severely impacts the quality of life of affected individuals. Like peripheral forms of trauma, TBI results from extraordinarily heterogeneous environmental forces being imparted on the cranial space, resulting in heterogeneous disease pathologies. This has made therapies for TBI notoriously difficult to develop, and currently, there are no FDA-approved pharmacotherapies specifically for the acute or chronic treatment of TBI. TBI is associated with changes in cognition and can precipitate the onset of debilitating psychiatric disorders like major depressive disorder (MDD), generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD). Complicating these effects of TBI, FDA-approved pharmacotherapies utilized to treat these disorders often fail to reach the desired level of efficacy in the context of neurotrauma. Although a complicated association, decades of work have linked central serotonin (5-HT) neurotransmission as being involved in the etiology of a myriad of neuropsychiatric disorders, including MDD and GAD. 5-HT is a biogenic monoamine neurotransmitter that is highly conserved across scales of biology. Though the majority of 5-HT is isolated to peripheral sites such as the gastrointestinal (GI) tract, 5-HT neurotransmission within the CNS exerts exquisite control over diverse biological functions, including sleep, appetite and respiration, while simultaneously establishing normal mood, perception, and attention. Although several key studies have begun to elucidate how various forms of neurotrauma impact central 5-HT neurotransmission, a full determination of precisely how TBI disrupts the highly regulated dynamics of 5-HT neuron function and/or 5-HT neurotransmission has yet to be conceptually or experimentally resolved. The purpose of the current review is, therefore, to integrate the disparate bodies of 5-HT and TBI research and synthesize insight into how new combinatorial research regarding 5-HT neurotransmission and TBI may offer an informed perspective into the nature of TBI-induced neuropsychiatric complications.
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Affiliation(s)
- Christopher J. O’Connell
- Division of Pharmaceutical Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267, USA; (C.J.O.); (R.S.B.); (T.M.P.)
| | - Ryan S. Brown
- Division of Pharmaceutical Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267, USA; (C.J.O.); (R.S.B.); (T.M.P.)
| | - Taylor M. Peach
- Division of Pharmaceutical Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267, USA; (C.J.O.); (R.S.B.); (T.M.P.)
| | - Owen D. Traubert
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC 27708, USA;
| | - Hana C. Schwierling
- Division of Pharmaceutical Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267, USA; (C.J.O.); (R.S.B.); (T.M.P.)
| | | | - Matthew J. Robson
- Division of Pharmaceutical Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267, USA; (C.J.O.); (R.S.B.); (T.M.P.)
- Neuroscience Graduate Program, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
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Chen Q, Bharadwaj V, Irvine KA, Clark JD. Mechanisms and treatments of chronic pain after traumatic brain injury. Neurochem Int 2023; 171:105630. [PMID: 37865340 DOI: 10.1016/j.neuint.2023.105630] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/13/2023] [Accepted: 10/15/2023] [Indexed: 10/23/2023]
Abstract
While pain after trauma generally resolves, some trauma patients experience pain for months to years after injury. An example, relevant to both combat and civilian settings, is chronic pain after traumatic brain injury (TBI). Headache as well as pain in the back and extremities are common locations for TBI-related chronic pain to be experienced. TBI-related pain can exist alone or can exacerbate pain from other injuries long after healing has occurred. Consequences of chronic pain in these settings include increased suffering, higher levels of disability, serious emotional problems, and worsened cognitive deficits. The current review will examine recent evidence regarding dysfunction of endogenous pain modulatory mechanisms, neuroplastic changes in the trigeminal circuitry and alterations in spinal nociceptive processing as contributors to TBI-related chronic pain. Key pain modulatory centers including the locus coeruleus, periaqueductal grey matter, and rostroventromedial medulla are vulnerable to TBI. Both the rationales and existing evidence for the use of monoamine reuptake inhibitors, CGRP antagonists, CXCR2 chemokine receptor antagonists, and interventional therapies will be presented. While consensus guidelines for the management of chronic post-traumatic TBI-related pain are lacking, several approaches to this clinically challenging situation deserve focused evaluation and may prove to be viable therapeutic options.
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Affiliation(s)
- QiLiang Chen
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, School of Medicine, Stanford, CA, 94305, USA
| | - Vimala Bharadwaj
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, School of Medicine, Stanford, CA, 94305, USA
| | - Karen-Amanda Irvine
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, School of Medicine, Stanford, CA, 94305, USA; Anesthesiology Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (E4-220), Palo Alto, CA, 94304, USA
| | - J David Clark
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, School of Medicine, Stanford, CA, 94305, USA; Anesthesiology Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (E4-220), Palo Alto, CA, 94304, USA.
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Rudolph M, Kopruszinski C, Wu C, Navratilova E, Schwedt TJ, Dodick DW, Porreca F, Anderson T. Identification of brain areas in mice with peak neural activity across the acute and persistent phases of post-traumatic headache. Cephalalgia 2023; 43:3331024231217469. [PMID: 38016977 PMCID: PMC11149587 DOI: 10.1177/03331024231217469] [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] [Indexed: 11/30/2023]
Abstract
BACKGROUND Post-traumatic headache is very common after a mild traumatic brain injury. Post-traumatic headache may persist for months to years after an injury in a substantial proportion of people. The pathophysiology underlying post-traumatic headache remains unknown but is likely distinct from other headache disorders. Identification of brain areas activated in acute and persistent phases of post-traumatic headache can provide insights into the underlying circuits mediating headache pain. We used an animal model of mild traumatic brain injury-induced post-traumatic headache and c-fos immunohistochemistry to identify brain regions with peak activity levels across the acute and persistent phases of post-traumatic headache. METHODS Male and female C57BL/6 J mice were briefly anesthetized and subjected to a sham procedure or a weight drop closed-head mild traumatic brain injury . Cutaneous allodynia was assessed in the periorbital and hindpaw regions using von Frey filaments. Immunohistochemical c-fos based neural activity mapping was then performed on sections from whole brain across the development of post-traumatic headache (i.e. peak of the acute phase at 2 days post- mild traumatic brain injury), start of the persistent phase (i.e. >14 days post-mild traumatic brain injury) or after provocation with stress (bright light). Brain areas with consistent and peak levels of c-fos expression across mild traumatic brain injury induced post-traumatic headache were identified and included for further analysis. RESULTS Following mild traumatic brain injury, periorbital and hindpaw allodynia was observed in both male and female mice. This allodynia was transient and subsided within the first 14 days post-mild traumatic brain injury and is representative of acute post-traumatic headache. After this acute post-traumatic headache phase, exposure of mild traumatic brain injury mice to a bright light stress reinstated periorbital and hindpaw allodynia for several hours - indicative of the development of persistent post-traumatic headache. Acute post-traumatic headache was coincident with an increase in neuronal c-fos labeling in the spinal nucleus of the trigeminal caudalis, primary somatosensory cortex, and the nucleus accumbens. Neuronal activation returned to baseline levels by the persistent post-traumatic headache phase in the spinal nucleus of the trigeminal caudalis and primary somatosensory cortex but remained elevated in the nucleus accumbens. In the persistent post-traumatic headache phase, coincident with allodynia observed following bright light stress, we observed bright light stress-induced c-fos neural activation in the spinal nucleus of the trigeminal caudalis, primary somatosensory cortex, and nucleus accumbens. CONCLUSION Examination of mild traumatic brain injury-induced changes in peak c-fos expression revealed brain regions with significantly increased neural activity across the acute and persistent phases of post-traumatic headache. Our findings suggest mild traumatic brain injury-induced post-traumatic headache produces neural activation along pain relevant pathways at time-points matching post-traumatic headache-like pain behaviors. These observations suggest that the spinal nucleus of the trigeminal caudalis, primary somatosensory cortex, and nucleus accumbens may contribute to both the induction and maintenance of post-traumatic headache.
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Affiliation(s)
- Megan Rudolph
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, Arizona, USA
- Department of Basic Medical Sciences, College of Medicine, University of Arizona, Phoenix, Arizona, USA
| | - Caroline Kopruszinski
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Chen Wu
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, Arizona, USA
- Department of Basic Medical Sciences, College of Medicine, University of Arizona, Phoenix, Arizona, USA
| | - Edita Navratilova
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, Arizona, USA
- Department of Neurology, Mayo Clinic, Phoenix, USA
| | | | - David W Dodick
- Mayo Clinic College of Medicine, Scottsdale, Arizona, USA
- Atria Academy of Science and Medicine, New York City, New York, USA
| | - Frank Porreca
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Trent Anderson
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, Arizona, USA
- Department of Basic Medical Sciences, College of Medicine, University of Arizona, Phoenix, Arizona, USA
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11
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Bharadwaj VN, Sahbaie P, Shi X, Irvine KA, Yeomans DC, Clark JD. Effect of Voluntary Exercise on Endogenous Pain Control Systems and Post-traumatic Headache in Mice. THE JOURNAL OF PAIN 2023; 24:1859-1874. [PMID: 37271350 DOI: 10.1016/j.jpain.2023.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 06/06/2023]
Abstract
Traumatic brain injury (TBI) can cause acute and chronic pain along with motor, cognitive, and emotional problems. Although the mechanisms are poorly understood, previous studies suggest disruptions in endogenous pain modulation may be involved. Voluntary exercise after a TBI has been shown to reduce some consequences of injury including cognitive impairment. We hypothesized, therefore, that voluntary exercise could augment endogenous pain control systems in a rodent model of TBI. For these studies, we used a closed-head impact procedure in male mice modeling mild TBI. We investigated the effect of voluntary exercise on TBI-induced hindpaw nociceptive sensitization, diffuse noxious inhibitory control failure, and periorbital sensitization after bright light stress, a model of post-traumatic headache. Furthermore, we investigated the effects of exercise on memory, circulating markers of brain injury, neuroinflammation, and spinal cord gene expression. We observed that exercise significantly reduced TBI-induced hindpaw allodynia and periorbital allodynia in the first week following TBI. We also showed that exercise improved the deficits associated with diffuse noxious inhibitory control and reduced bright light stress-induced allodynia up to 2 months after TBI. In addition, exercise preserved memory and reduced TBI-induced increases in spinal BDNF, CXCL1, CXCL2, and prodynorphin expression, all genes previously linked to TBI-induced nociceptive sensitization. Taken together, our observations suggest that voluntary exercise may reduce pain after TBI by reducing TBI-induced changes in nociceptive signaling and preserving endogenous pain control systems. PERSPECTIVE: This article evaluates the effects of exercise on pain-related behaviors in a preclinical model of traumatic brain injury (TBI). The findings show that exercise reduces nociceptive sensitization, loss of diffuse noxious inhibitory control, memory deficits, and spinal nociception-related gene expression after TBI. Exercise may reduce or prevent pain after TBI.
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Affiliation(s)
- Vimala N Bharadwaj
- Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, School of Medicine, Stanford, California.
| | - Peyman Sahbaie
- Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, School of Medicine, Stanford, California; Anesthesiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Xiaoyou Shi
- Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, School of Medicine, Stanford, California; Anesthesiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Karen-Amanda Irvine
- Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, School of Medicine, Stanford, California; Anesthesiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - David C Yeomans
- Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, School of Medicine, Stanford, California
| | - J David Clark
- Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, School of Medicine, Stanford, California; Anesthesiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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12
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Walker WC, Clark SW, Eppich K, Wilde EA, Martin AM, Allen CM, Cortez MM, Pugh MJ, Walton SR, Kenney K. Headache among combat-exposed veterans and service members and its relation to mild traumatic brain injury history and other factors: a LIMBIC-CENC study. Front Neurol 2023; 14:1242871. [PMID: 37808506 PMCID: PMC10552781 DOI: 10.3389/fneur.2023.1242871] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Background Headache (HA) is a common persistent complaint following mild traumatic brain injury (mTBI), but the association with remote mTBI is not well established, and risk factors are understudied. Objective Determine the relationship of mTBI history and other factors with HA prevalence and impact among combat-exposed current and former service members (SMs). Design Secondary cross-sectional data analysis from the Long-Term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium prospective longitudinal study. Methods We examined the association of lifetime mTBI history, demographic, military, medical and psychosocial factors with (1) HA prevalence ("lately, have you experienced headaches?") using logistic regression and (2) HA burden via the Headache Impact Test-6 (HIT-6) using linear regression. Each lifetime mTBI was categorized by mechanism (blast-related or not) and setting (combat deployed or not). Participants with non-credible symptom reporting were excluded, leaving N = 1,685 of whom 81% had positive mTBI histories. Results At a median 10 years since last mTBI, mTBI positive participants had higher HA prevalence (69% overall, 78% if 3 or more mTBIs) and greater HA burden (67% substantial/severe impact) than non-TBI controls (46% prevalence, 54% substantial/severe impact). In covariate-adjusted analysis, HA prevalence was higher with greater number of blast-related mTBIs (OR 1.81; 95% CI 1.48, 2.23), non-blast mTBIs while deployed (OR 1.42; 95% CI 1.14, 1.79), or non-blast mTBIs when not deployed (OR 1.23; 95% CI 1.02, 1.49). HA impact was only higher with blast-related mTBIs. Female identity, younger age, PTSD symptoms, and subjective sleep quality showed effects in both prevalence and impact models, with the largest mean HIT-6 elevation for PTSD symptoms. Additionally, combat deployment duration and depression symptoms were factors for HA prevalence, and Black race and Hispanic/Latino ethnicity were factors for HA impact. In sensitivity analyses, time since last mTBI and early HA onset were both non-significant. Conclusion The prevalence of HA symptoms among formerly combat-deployed veterans and SMs is higher with more lifetime mTBIs regardless of how remote. Blast-related mTBI raises the risk the most and is uniquely associated with elevated HA burden. Other demographic and potentially modifiable risk factors were identified that may inform clinical care.
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Affiliation(s)
- William C. Walker
- Department of Physical Medicine and Rehabilitation (PM&R), School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
- Richmond Veterans Affairs (VA) Medical Center, Central Virginia VA Health Care System, Richmond, VA, United States
| | - Sarah W. Clark
- Richmond Veterans Affairs (VA) Medical Center, Central Virginia VA Health Care System, Richmond, VA, United States
| | - Kaleb Eppich
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Elisabeth A. Wilde
- George E. Wahlen VA Salt Lake City Healthcare System, Salt Lake City, UT, United States
- Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City, UT, United States
| | - Aaron M. Martin
- Mental Health and Behavioral Science Service, James A. Haley Veterans’ Hospital, Tampa, FL, United States
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States
| | - Chelsea M. Allen
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Melissa M. Cortez
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, Salt Lake City, UT, United States
- Department of Internal Medicine, Division of Epidemiology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Samuel R. Walton
- Department of Physical Medicine and Rehabilitation (PM&R), School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Kimbra Kenney
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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13
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Martindale C, Presson AP, Schwedt TJ, Brennan KC, Cortez MM. Sensory hypersensitivities are associated with post-traumatic headache-related disability. Headache 2023; 63:1061-1069. [PMID: 37638410 PMCID: PMC10854013 DOI: 10.1111/head.14604] [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: 01/05/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE To examine whether sensory hypersensitivity contributes to headache-related disability in a secondary analysis of patients with post-traumatic headache. BACKGROUND Up to one-third of individuals with traumatic brain injuries report persistent headache 3 months post-injury. High rates of allodynia and photophobia have been observed in clinical studies and animal models of post-traumatic headache, but we do not fully understand how sensory amplifications impact post-traumatic headache-related disability. METHODS We identified a cross-sectional sample of patients from the American Registry for Migraine Research database with new or worsening headaches post-head injury from 2016 to 2020 and performed a secondary analysis of those data. We modeled the relationship between sensory sensitivity and Migraine Disability Assessment scores using questionnaires. Candidate variables included data collection features (study site and year), headache-related and general clinical features (headache frequency, migraine diagnosis, abuse history, sex, age, cognitive and affective symptom scores), and sensory symptoms (related to light, sound, and touch sensitivity). RESULTS The final sample included 193 patients (median age 46, IQR 22; 161/193, 83.4% female). Migraine Disability Assessment scores ranged from 0 to 260 (median 47, IQR 87). The final model included allodynia, hyperacusis, photosensitivity, headache days per month, abuse history, anxiety and depression, cognitive dysfunction, and age (R2 = 0.43). An increase of one point in allodynia score corresponded to a 3% increase in headache disability (95% CI: 0%-7%; p = 0.027), an increase of one-tenth of a point in the photosensitivity score corresponded to a 12% increase (95% CI: 3%-25%; p = 0.002), and an increase of one point in the hyperacusis score corresponded to a 2% increase (95% CI: 0%-4%; p = 0.016). CONCLUSIONS Increased photosensitivity, allodynia, and hyperacusis were associated with increased headache-related disability in this sample of patients with post-traumatic headache. Symptoms of sensory amplification likely contribute to post-traumatic headache-related disability and merit an ongoing investigation into their potential as disease markers and treatment targets.
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Affiliation(s)
| | - Angela P. Presson
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | | | - K. C. Brennan
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Melissa M. Cortez
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
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14
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Wong KR, Wright DK, Sgro M, Salberg S, Bain J, Li C, Sun M, McDonald SJ, Mychasiuk R, Brady RD, Shultz SR. Persistent Changes in Mechanical Nociception in Rats With Traumatic Brain Injury Involving Polytrauma. THE JOURNAL OF PAIN 2023; 24:1383-1395. [PMID: 36958460 DOI: 10.1016/j.jpain.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 03/25/2023]
Abstract
Traumatic brain injury (TBI) survivors often experience debilitating consequences. Due to the high impact nature of TBI, patients often experience concomitant peripheral injuries (ie, polytrauma). A common, yet often overlooked, comorbidity of TBI is chronic pain. Therefore, this study investigated how common concomitant peripheral injuries (ie, femoral fracture and muscle crush) can affect long-term behavioral and structural TBI outcomes with a particular focus on nociception. Rats were randomly assigned to 1 of 4 groups: polytrauma (POLY; ie, fracture + muscle crush + TBI), peripheral injury (PERI; ie, fracture + muscle crush + sham TBI), TBI (ie, sham fracture + sham muscle crush + TBI), and sham-injured (SHAM; ie, sham fracture + sham muscle crush + sham TBI). Rats underwent behavioral testing at 3-, 6-, and 11-weeks postinjury, and were then euthanized for postmortem magnetic resonance imaging (MRI). POLY rats had a persisting increase in pain sensitivity compared to all groups on the von Frey test. MRI revealed that POLY rats also had abnormalities in the cortical and subcortical brain structures involved in nociceptive processing. These findings have important implications and provide a foundation for future studies to determine the underlying mechanisms and potential treatment strategies for chronic pain in TBI survivors. PERSPECTIVE: Rats with TBI and concomitant peripheral trauma displayed chronic nociceptive pain and MRI images also revealed damaged brain structures/pathways that are involved in chronic pain development. This study highlights the importance of polytrauma and the affected brain regions for developing chronic pain.
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Affiliation(s)
- Ker Rui Wong
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - David K Wright
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Marissa Sgro
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Sabrina Salberg
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Jesse Bain
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Crystal Li
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Mujun Sun
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Stuart J McDonald
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia; Department of Physiology, Anatomy and Microbiology, School of Life Sciences, La Trobe University, Bundoora, VIC, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Rhys D Brady
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia; Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia; Department of Medicine, The University of Melbourne, Parkville, VIC, Australia; Department of Nursing, Health and Human Services, Vancouver Island University, Nanaimo, BC, Canada.
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15
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Cherup NP, Robayo LE, Vastano R, Fleming L, Levin BE, Widerström-Noga E. Neuropsychological Function in Traumatic Brain Injury and the Influence of Chronic Pain. Percept Mot Skills 2023; 130:1495-1523. [PMID: 37219529 DOI: 10.1177/00315125231174082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Cognitive dysfunction, pain, and psychological morbidity all present unique challenges to those living with traumatic brain injury (TBI). In this study we examined (a) the impact of pain across domains of attention, memory, and executive function, and (b) the relationships between pain and depression, anxiety, and post-traumatic stress disorder (PTSD) in persons with chronic TBI. Our sample included 86 participants with a TBI and chronic pain (n = 26), patients with TBI and no chronic pain (n = 23), and a pain-free control group without TBI (n = 37). Participants visited the laboratory and completed a comprehensive battery of neuropsychological tests as part of a structured interview. Multivariate analysis of covariance using education as a covariate, failed to detect a significant group difference for neuropsychological composite scores of attention, memory, and executive function (p = .165). A follow-up analysis using multiple one-way analysis of variance (ANOVA) was conducted for individual measures of executive function. Post-hoc testing indicated that those in both TBI groups preformed significantly worse on measures of semantic fluency when compared to controls (p < 0.001, ηρ2 = .16). Additionally, multiple ANOVAs indicated that those with TBI and pain scored significantly worse across all psychological assessments (p < .001). We also found significant associations between measures of pain and most psychological symptoms. A follow-up stepwise linear regression among those in the TBI pain group indicated that post concussive complaints, pain severity, and neuropathic pain symptoms differentially contributed to symptoms of depression, anxiety, and PTSD. These findings suggest deficits in verbal fluency among those living with chronic TBI, with results also reinforcing the multidimensional nature of pain and its psychological significance in this population.
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Affiliation(s)
- Nicholas P Cherup
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, FL, USA
| | - Linda E Robayo
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, FL, USA
| | - Roberta Vastano
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, FL, USA
| | - Loriann Fleming
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, FL, USA
| | - Bonnie E Levin
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eva Widerström-Noga
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, FL, USA
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
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16
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Salberg S, Macowan M, Yamakawa GR, Beveridge JK, Noel M, Marsland BJ, Mychasiuk R. Gut instinct: Sex differences in the gut microbiome are associated with changes in adolescent nociception following maternal separation in rats. Dev Neurobiol 2023; 83:219-233. [PMID: 37488954 DOI: 10.1002/dneu.22925] [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: 03/27/2023] [Revised: 07/06/2023] [Accepted: 07/13/2023] [Indexed: 07/26/2023]
Abstract
Adolescent chronic pain is a growing public health epidemic. Our understanding of its etiology is limited; however, several factors can increase susceptibility, often developing in response to an acute pain trigger such as a surgical procedure or mild traumatic brain injury (mTBI), or an adverse childhood experience (ACE). Additionally, the prevalence and manifestation of chronic pain is sexually dimorphic, with double the rates in females than males. Despite this, the majority of pre-clinical pain research focuses on males, leaving a gap in mechanistic understanding for females. Given that emerging evidence has linked the gut microbiome and the brain-gut-immune axis to various pain disorders, we aimed to investigate sex-dependent changes in taxonomic and functional gut microbiome features following an ACE and acute injury as chronic pain triggers. Male and female Sprague Dawley rat pups were randomly assigned to either a maternal separation (MS) or no stress paradigm, then further into a sham, mTBI, or surgery condition. Chronically, the von Frey test was used to measure mechanical nociception, and fecal samples were collected for 16S rRNA sequencing. Animals in the surgery group had an increase in pain sensitivity when compared to mTBI and sham groups, and this was complemented by changes to the gut microbiome. In addition, significant sex differences were identified in gut microbiome composition, which were exacerbated in response to MS. Overall, we provide preliminary evidence for sex differences and ACE-induced changes in bacterial composition that, when combined, may be contributing to heterogeneity in pain outcomes.
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Affiliation(s)
- Sabrina Salberg
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Matthew Macowan
- Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Glenn R Yamakawa
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Jaimie K Beveridge
- Department of Psychology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, The University of Calgary, Calgary, Alberta, Canada
| | - Melanie Noel
- Department of Psychology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, The University of Calgary, Calgary, Alberta, Canada
| | - Benjamin J Marsland
- Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
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17
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Collett E, Wang T, Todd C, Dosaj A, Baker A, Hunt C. Enhanced education for adult patients with persistent post-concussion headaches: a randomized controlled trial. CONCUSSION (LONDON, ENGLAND) 2022; 7:CNC102. [PMID: 36687215 PMCID: PMC9841394 DOI: 10.2217/cnc-2022-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/09/2022] [Indexed: 01/05/2023]
Abstract
Aim & Patients We conducted a randomized clinical trial to determine if an e-learning intervention can enhance recovery in adult patients with persistent post-concussion headaches (PPCH). Materials & Methods The intervention consisted of three e-learning modules administered at baseline, 6 and 12 weeks. Data were collected on symptoms, community integration, quality of life and healthcare utilization at baseline and 12-week follow-up. ANCOVA was conducted to compare changes. Results No statistically significant difference was observed on symptoms although we observed a trend toward reduced healthcare utilization and improved quality of life in the intervention group. Conclusion E-learning modules for patients experiencing PPCH warrant further investigation with data on participant compliance and measures focusing on simpler short-term outcomes.Clinical Trial Registration: NCT03391583 (ClinicalTrials.gov).
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Affiliation(s)
- Emily Collett
- Dalla Lana School of Public Health, University of Toronto, Toronto, M5T 3M7, Ontario, Canada
| | - Tianru Wang
- Dalla Lana School of Public Health, University of Toronto, Toronto, M5T 3M7, Ontario, Canada
| | - Candice Todd
- Division of Neurology, University of Toronto, Toronto, M5S 3H2, Ontario, Canada,Head Injury Clinic, St. Michael's Hospital, Unity Health, Toronto, M5B 1W8, Ontario, Canada
| | - Anil Dosaj
- Head Injury Clinic, St. Michael's Hospital, Unity Health, Toronto, M5B 1W8, Ontario, Canada,Concussion Ontario Network, Ontario Brain Institute, Toronto, M5H 3W4, Ontario, Canada
| | - Andrew Baker
- Head Injury Clinic, St. Michael's Hospital, Unity Health, Toronto, M5B 1W8, Ontario, Canada,Concussion Ontario Network, Ontario Brain Institute, Toronto, M5H 3W4, Ontario, Canada,Department of Anesthesia & Surgery, University of Toronto, Toronto, M5G 1E2, Ontario, Canada
| | - Cindy Hunt
- Dalla Lana School of Public Health, University of Toronto, Toronto, M5T 3M7, Ontario, Canada,Head Injury Clinic, St. Michael's Hospital, Unity Health, Toronto, M5B 1W8, Ontario, Canada,Concussion Ontario Network, Ontario Brain Institute, Toronto, M5H 3W4, Ontario, Canada,Author for correspondence: Tel.: +1 289 795 6843;
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18
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Glutamate, GABA and glutathione in adults with persistent post-concussive symptoms. Neuroimage Clin 2022; 36:103152. [PMID: 36007438 PMCID: PMC9424629 DOI: 10.1016/j.nicl.2022.103152] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/23/2022] [Accepted: 08/12/2022] [Indexed: 12/14/2022]
Abstract
Persistent post-concussive symptoms (PPCS) are debilitating and endure beyond the usual recovery period after mild traumatic brain injury (mTBI). Altered neurotransmission, impaired energy metabolism and oxidative stress have been examined acutely post-injury but have not been explored extensively in those with persistent symptoms. Specifically, the antioxidant glutathione (GSH) and the excitatory and inhibitory metabolites, glutamate (Glu) and γ-aminobutyric acid (GABA), are seldom studied together in the clinical mTBI literature. While Glu can be measured using conventional magnetic resonance spectroscopy (MRS) methods at 3 Tesla, GABA and GSH require the use of advanced MRS methods. Here, we used the recently established Hadamard Encoding and Reconstruction of MEGA-Edited Spectroscopy (HERMES) to simultaneously measure GSH and GABA and short-echo time point resolved spectroscopy (PRESS) to measure Glu to gain new insight into the pathophysiology of PPCS. Twenty-nine adults with PPCS (mean age: 45.69 years, s.d.: 10.73, 22 females, 7 males) and 29 age- and sex-matched controls (mean age: 43.69 years, s.d.: 11.00) completed magnetic resonance spectroscopy scans with voxels placed in the anterior cingulate and right sensorimotor cortex. Relative to controls, anterior cingulate Glu was significantly reduced in PPCS. Higher anterior cingulate GABA was significantly associated with a higher number of lifetime mTBIs, suggesting GABA may be upregulated with repeated incidence of mTBI. Furthermore, GSH in both regions of interest was positively associated with symptoms of sleepiness and headache burden. Collectively, our findings suggest that the antioxidant defense system is active in participants with PPCS, however this may be at the expense of other glutamatergic functions such as cortical excitation and energy metabolism.
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19
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Valbuena Valecillos AD, Gater DR, Alvarez G. Concomitant Brain Injury and Spinal Cord Injury Management Strategies: A Narrative Review. J Pers Med 2022; 12:1108. [PMID: 35887605 PMCID: PMC9324293 DOI: 10.3390/jpm12071108] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 12/02/2022] Open
Abstract
Spinal cord injury (SCI) is a catastrophic event with multiple comorbidities including spastic paralysis, sensory loss, autonomic dysfunction with sympathetic blunting, neurogenic orthostatic hypotension, neurogenic restrictive and obstructive lung disease, neuropathic pain, spasticity, neurogenic bladder, neurogenic bowel, immobilization hypercalcemia, osteopenia/osteoporosis, neurogenic obesity, and metabolic dysfunction. Cervical and thoracic SCI is all too often accompanied by traumatic brain injury (TBI), which carries its own set of comorbidities including headaches, seizures, paroxysmal sympathetic hyperactivity, aphasia, dysphagia, cognitive dysfunction, memory loss, agitation/anxiety, spasticity, bladder and bowel incontinence, and heterotopic ossification. This manuscript will review the etiology and epidemiology of dual diagnoses, assessment of both entities, and discuss some of the most common comorbidities and management strategies to optimize functional recovery.
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Affiliation(s)
- Adriana D. Valbuena Valecillos
- Department of Physical Medicine and Rehabilitation, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (D.R.G.J.); (G.A.)
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (D.R.G.J.); (G.A.)
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
- The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Gemayaret Alvarez
- Department of Physical Medicine and Rehabilitation, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (D.R.G.J.); (G.A.)
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
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McGeary DD, Resick PA, Penzien DB, McGeary CA, Houle TT, Eapen BC, Jaramillo CA, Nabity PS, Reed DE, Moring JC, Bira LM, Hansen HR, Young-McCaughan S, Cobos BA, Mintz J, Keane TM, Peterson AL. Cognitive Behavioral Therapy for Veterans With Comorbid Posttraumatic Headache and Posttraumatic Stress Disorder Symptoms: A Randomized Clinical Trial. JAMA Neurol 2022; 79:746-757. [PMID: 35759281 PMCID: PMC9237802 DOI: 10.1001/jamaneurol.2022.1567] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Question Do cognitive behavioral therapies for posttraumatic headache and posttraumatic stress disorder (PTSD) symptoms improve headache-related disability in veterans compared with treatment per usual? Findings A randomized clinical trial of 193 post-9/11 combat veterans with posttraumatic headache and PTSD symptoms found headache disability was significantly improved with cognitive behavioral therapy for headaches compared with treatment per usual. Though participants randomly assigned to cognitive processing therapy reported significantly greater improvement in PTSD symptom severity compared with treatment per usual, there was no significant effect of cognitive processing therapy on headache disability. Meaning Cognitive behavioral therapies are efficacious treatments for veterans with comorbid posttraumatic headache and PTSD symptoms. Importance Posttraumatic headache is the most disabling complication of mild traumatic brain injury. Posttraumatic stress disorder (PTSD) symptoms are often comorbid with posttraumatic headache, and there are no established treatments for this comorbidity. Objective To compare cognitive behavioral therapies (CBTs) for headache and PTSD with treatment per usual (TPU) for posttraumatic headache attributable to mild traumatic brain injury. Design, Setting, and Participants This was a single-site, 3–parallel group, randomized clinical trial with outcomes at posttreatment, 3-month follow-up, and 6-month follow-up. Participants were enrolled from May 1, 2015, through May 30, 2019; data collection ended on October 10, 2019. Post-9/11 US combat veterans from multiple trauma centers were included in the study. Veterans had comorbid posttraumatic headache and PTSD symptoms. Data were analyzed from January 20, 2020, to February 2, 2022. Interventions Patients were randomly assigned to 8 sessions of CBT for headache, 12 sessions of cognitive processing therapy for PTSD, or treatment per usual for headache. Main Outcomes and Measures Co–primary outcomes were headache-related disability on the 6-Item Headache Impact Test (HIT-6) and PTSD symptom severity on the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PCL-5) assessed from treatment completion to 6 months posttreatment. Results A total of 193 post-9/11 combat veterans (mean [SD] age, 39.7 [8.4] years; 167 male veterans [87%]) were included in the study and reported severe baseline headache-related disability (mean [SD] HIT-6 score, 65.8 [5.6] points) and severe PTSD symptoms (mean [SD] PCL-5 score, 48.4 [14.2] points). For the HIT-6, compared with usual care, patients receiving CBT for headache reported −3.4 (95% CI, −5.4 to −1.4; P < .01) points lower, and patients receiving cognitive processing therapy reported −1.4 (95% CI, −3.7 to 0.8; P = .21) points lower across aggregated posttreatment measurements. For the PCL-5, compared with usual care, patients receiving CBT for headache reported −6.5 (95% CI, −12.7 to −0.3; P = .04) points lower, and patients receiving cognitive processing therapy reported −8.9 (95% CI, −15.9 to −1.9; P = .01) points lower across aggregated posttreatment measurements. Adverse events were minimal and similar across treatment groups. Conclusions and Relevance This randomized clinical trial demonstrated that CBT for headache was efficacious for disability associated with posttraumatic headache in veterans and provided clinically significant improvement in PTSD symptom severity. Cognitive processing therapy was efficacious for PTSD symptoms but not for headache disability. Trial Registration ClinicalTrials.gov Identifier: NCT02419131
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Affiliation(s)
- Donald D McGeary
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio.,Department of Rehabilitation Medicine, The University of Texas Health Science Center at San Antonio, San Antonio.,South Texas Veterans Health Care System, San Antonio.,Department of Psychology, The University of Texas at San Antonio, San Antonio
| | - Patricia A Resick
- Department of Psychiatry and Behavioral Sciences, Duke Health, Durham, North Carolina
| | - Donald B Penzien
- Departments of Psychiatry and Behavioral Medicine & Neurology, Wake Forest University, Winston-Salem, North Carolina
| | - Cindy A McGeary
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio.,South Texas Veterans Health Care System, San Antonio
| | - Timothy T Houle
- Department of Anesthesia, Massachusetts General Hospital, Boston
| | - Blessen C Eapen
- Greater Los Angeles Veterans Health Care System, Los Angeles, California.,Department of Physical Medicine and Rehabilitation, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
| | - Carlos A Jaramillo
- Department of Rehabilitation Medicine, The University of Texas Health Science Center at San Antonio, San Antonio.,South Texas Veterans Health Care System, San Antonio
| | - Paul S Nabity
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio.,South Texas Veterans Health Care System, San Antonio
| | - David E Reed
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio
| | - John C Moring
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio.,South Texas Veterans Health Care System, San Antonio
| | - Lindsay M Bira
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio
| | - Hunter R Hansen
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio.,South Texas Veterans Health Care System, San Antonio
| | - Briana A Cobos
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio.,Department of Psychology, The University of Texas at San Antonio, San Antonio
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio.,South Texas Veterans Health Care System, San Antonio
| | - Terence M Keane
- Behavioral Science Division, National Center for PTSD, Boston, Massachusetts.,VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio.,South Texas Veterans Health Care System, San Antonio.,Department of Psychology, The University of Texas at San Antonio, San Antonio
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Pease M, Zaher M, Lopez AJ, Yu S, Egodage T, Semroc S, Arefan D, Jankowitz B. Multicenter and prospective trial of anti-epileptics for early seizure prevention in mild traumatic brain injury with a positive computed tomography scan. Surg Neurol Int 2022; 13:241. [PMID: 35855176 PMCID: PMC9282794 DOI: 10.25259/sni_38_2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Posttraumatic seizures (PTSs) are a major source of disability after traumatic brain injury (TBI). The Brain Trauma Foundation Guidelines recommend prophylactic anti-epileptics (AEDs) for early PTS in severe TBI, but high-quality evidence is lacking in mild TBI. Methods: To determine the benefit of administering prophylactic AEDs, we performed a prospective and multicenter study evaluating consecutive patients who presented to a Level 1 trauma center from January 2017 to December 2020. We included all patients with mild TBI defined as Glasgow Coma Scale (GCS) 13–15 and a positive head computed tomography (CT). Patients were excluded for previous seizure history, current AED use, or a neurosurgical procedure. Patients were given a prophylactic 7-day course of AEDs on a week-on versus week-off basis and followed with in-person clinic visits, in-hospital evaluation, or a validated phone questionnaire. Results: Four hundred and ninety patients were enrolled, 349 (71.2%) had follow-up, and 139 (39.8%) were given prophylactic AEDs. There was no difference between seizure rates for the prophylactic AED group (0.7%) and those without (2.9%; P = 0.25). Patients who had a PTS were on average older (81.4 years) than patients without a seizure (64.8 years; P = 0.02). Seizure rate increased linearly by age groups: <60 years old (0%); 60–70 years old (1.7%); 70–80 years old (2.3%); and >80 years old (4.6%). Conclusion: Prophylactic AEDs did not provide a benefit for PTS reduction in mild TBI patients with a positive CT head scan.
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Affiliation(s)
- Matthew Pease
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Mazen Zaher
- Department of Neurosurgery, Medical School, Cooper University, Camden, United States
| | - Alejandro J. Lopez
- Department of Neurosurgery, Medical School, Cooper University, Camden, United States
| | - Siyuan Yu
- Department of Neurosurgery, Medical School, Cooper University, Camden, United States
| | - Tanya Egodage
- Department of General Surgery, Cooper University Hospital, Camden, United States
| | - Suzan Semroc
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Dooman Arefan
- Department of Radiology, University of Pittsburgh, Pittsburgh, United States
| | - Brian Jankowitz
- Department of Neurosurgery, Medical School, Cooper University, Camden, United States
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Navratilova E, Oyarzo J, Anderson T, Broide RS, Subramaniam SR, Vazquez-Cintron EJ, Brin MF, Schwedt TJ, Dodick DW, Porreca F. Preclinical assessment of onabotulinumtoxinA for the treatment of mild traumatic brain injury-related acute and persistent post-traumatic headache. Cephalalgia 2022; 42:1194-1206. [PMID: 35546268 PMCID: PMC9535972 DOI: 10.1177/03331024221099841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective Investigation of onabotulinumtoxinA in a murine model of acute and persistent post-traumatic headache. Methods Mild traumatic brain injury was induced with a weight drop method. Periorbital and hindpaw cutaneous allodynia were measured for 14 days. Mice were then exposed to bright light stress and allodynia was reassessed. OnabotulinumtoxinA (0.5 U) was injected subcutaneously over the cranial sutures at different post-injury time points. Results After milt traumatic brain injury, mice exhibited periorbital and hindpaw allodynia that lasted for approximately 14 days. Allodynia could be reinstated on days 14–67 by exposure to stress only in previously injured mice. OnabotulinumtoxinA administration at 2 h after mild traumatic brain injury fully blocked both transient acute and stress-induced allodynia up to day 67. When administered 72 h post-mild traumatic brain injury, onabotulinumtoxinA reversed acute allodynia, but only partially prevented stress-induced allodynia. OnabotulinumtoxinA administration at day 12, when initial allodynia was largely resolved, produced incomplete and transient prevention of stress-induced allodynia. The degree of acute allodynia correlated positively with subsequent stress-induced allodynia. Conclusion Mild traumatic brain injury induced transient headache-like pain followed by long lasting sensitization and persistent vulnerability to a normally innocuous stress stimulus, respectively modeling acute and persistent post-traumatic headache.. Administration of onabotulinumtoxinA following the resolution of acute post-traumatic headache diminished persistent post-traumatic headache but the effects were transient, suggesting that underlying persistent mild traumatic brain injury-induced maladaptations were not reversed. In contrast, early onabotulinumtoxinA administration fully blocked both acute post-traumatic headache as well as the transition to persistent post-traumatic headache suggesting prevention of neural adaptations that promote vulnerability to headache-like pain. Additionally, the degree of acute post-traumatic headache was predictive of risk of persistent post-traumatic headache.
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Affiliation(s)
- Edita Navratilova
- Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ, USA
| | | | - Trent Anderson
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, AZ, USA
| | | | | | | | - Mitchell F Brin
- Allergan Aesthetics, an AbbVie Company, USA.,Department of Neurology, University of California, Irvine, CA, USA
| | | | | | - Frank Porreca
- Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ, USA.,Mayo Clinic, Scottsdale, AZ, USA
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Blumenfeld A, McVige J, Knievel K. Post-traumatic headache: Pathophysiology and management - A review. JOURNAL OF CONCUSSION 2022. [DOI: 10.1177/20597002221093478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Post-traumatic headache (PTH) is a common secondary headache due to traumatic brain injury. In the past, significant research has been conducted to understand the pathophysiology and treatment options for PTH. However, PTH still lacks evidence-based treatment, and most of the management depends on the primary phenotype observed in the patient. Objective The main objective of this review is to provide a single reference that covers the current understanding of the pathophysiology and the treatment options available for PTH. Methods A detailed literature search on PubMed was performed, and a narrative review was prepared. Results The pathophysiology of PTH is multifactorial. Acute PTH may be attributed to increased peripheral pain sensitization with impaired pain inhibiting pathways. Chronic or persistent PTH may be due to a chronic inflammatory response and peripheral as well as central sensitization. The mechanism responsible for the transition of acute to persistent PTH is unknown. The migraine-like phenotype is reported to be the most prevalent headache type seen in PTH. New targets for preventive treatment have been identified in recent years, such as neuropeptides like calcitonin-gene-related peptide (CGRP), nitric oxide, and glutamate. The preventive pharmacological and non-pharmacological strategies employed for migraine (e.g. anti-CGRP monoclonal antibodies, onabotulinumtoxinA, physical therapy, cognitive and behavioral treatment, and neurostimulation techniques) have shown in preliminary studies that they are potentially efficacious, but large, randomized, double blind, placebo controlled trials are needed to further establish these as treatment options for PTH. Conclusions The lack of evidence-based treatment for PTH has created a need for future large trials to confirm the safety and efficacy of the currently employed treatments.
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Affiliation(s)
- Andrew Blumenfeld
- The Los Angeles Headache Center and The San Diego Headache Center, Los Angeles, CA, USA
| | | | - Kerry Knievel
- Barrow Neurological Institute, Phoenix, Arizona, USA
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24
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Bassett A, Vanstrum E. Exploring Vestibular Assessment in Patients with Headache and Dizziness. Otolaryngol Clin North Am 2022; 55:549-558. [PMID: 35490043 DOI: 10.1016/j.otc.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Patients often report symptoms of headache and dizziness concomitantly. Symptoms of dizziness can be explored with a comprehensive vestibular assessment, allowing for the investigation of central and peripheral vestibular system contributions to symptoms of dizziness. Patients who report both symptoms of headache and dizziness demonstrate abnormalities of the vestibular system which can be measured quantitatively. Completion of comprehensive vestibular testing can help to guide diagnosis and strategies for intervention.
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Affiliation(s)
- Alaina Bassett
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine of the University of Southern California, 1640 Marengo Street, Suite 100, Los Angeles, CA 90033, USA.
| | - Erik Vanstrum
- Keck School of Medicine of the University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90033, USA
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25
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Headache Diary Mobile Application for Monitoring and Characterizing Posttraumatic Headaches. J Head Trauma Rehabil 2022; 37:171-177. [PMID: 35293366 DOI: 10.1097/htr.0000000000000771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study analyzed the data collected using a headache diary mobile application to characterize posttraumatic headaches (PTHs) in a sample of US veterans. Specifically, we measured patient engagement with the mobile application and compared our findings with previous literature regarding PTHs. SETTING A Headache Center of Excellence (HCoE) in a Veterans Health Administration facility. PARTICIPANTS Forty-nine veterans currently being treated for ongoing PTH-related complaints with English fluency, reliable access to the internet, and a mobile phone. DESIGN Observational study of PTH characteristics using the mobile application over the course of 1 year. MEASURES Main outcome measures were collected via a headache diary mobile application developed for patients to track headache-associated symptoms, headache location, triggers, type, intensity, and duration. Patients also completed a baseline Headache Impact Test (HIT-6) survey. RESULTS In total, 1569 entries were completed during the first year of application deployment. On average, patients completed 2.5 entries per week and used the application for 70 days. They frequently reported associated PTH symptoms of photophobia (56.7%) and headaches triggered by emotional stress (35.1%). Network analyses revealed patterns of co-occurrence in triggers of headache pain, associated symptoms, and headache pain location. Headache pain severity and impact ratings from the headache diary demonstrated convergent validity with the established HIT-6 measure. CONCLUSIONS Headache diary mobile applications are a promising tool for monitoring and characterizing PTHs in veterans. Present results mirror past studies of PTH characteristics. Mobile application headache diaries may be used in both clinical and research settings to monitor headache symptoms and communicate the functional impact of headaches in real time.
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26
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Nabity PS, Jaramillo CA, Resick PA, McGeary CA, Eapen BC, Straud CL, Hale WJ, Houle TT, Litz BT, Mintz J, Penzien DB, Young-McCaughan S, Keane TM, Peterson AL, McGeary DD. Persistent posttraumatic headaches and functioning in veterans: Injury type can matter. Headache 2021; 61:1334-1341. [PMID: 34570899 DOI: 10.1111/head.14210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/20/2021] [Accepted: 07/19/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To characterize the relationship between head trauma types (blast injury, blunt injury, combined blast+blunt injury) with subsequent headache presentations and functioning. BACKGROUND Posttraumatic headaches (PTHs), the most common sequelae of traumatic brain injury (TBI), are painful and disabling. More than 400,000 veterans report having experienced a TBI, and understanding the predictors of PTHs may guide treatment developments. METHODS This study used a nested-cohort design analyzing baseline data from a randomized clinical trial of cognitive behavioral therapy for PTH (N = 190). Participants had PTH (from blast and/or blunt head trauma) and symptoms of posttraumatic stress disorder (PTSD). The Structured Diagnostic Interview for Headache-Revised and Ohio State University Traumatic Brain Injury Identification Method were used to phenotype headaches and head injury histories, respectively. RESULTS Individuals with persistent PTHs after a combined blast and blunt head trauma were more likely (OR =3.45; 95% CI [1.41, 8.4]) to experience chronic (vs. episodic) PTHs compared with the blunt trauma only group (23/33, 70% vs. 26/65, 40%, respectively); and they were more likely (OR =2.51; 95% CI [1.07, 5.9]) to experience chronic PTH compared with the blast trauma only group (44/92, 48%). There were no differences between head injury type on headache-related disability, depression symptoms, or severity of PTSD symptoms. CONCLUSION The combination of blast and blunt injuries was associated with headache chronicity, but not headache disability. Considering the refractory nature of chronic headaches, the potential added and synergistic effects of distinct head injuries warrant further study.
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Affiliation(s)
- Paul S Nabity
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Carlos A Jaramillo
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, Texas, USA.,Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Patricia A Resick
- Department of Psychiatry and Behavioral Sciences, Duke Health, Durham, North Carolina, USA
| | - Cindy A McGeary
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Blessen C Eapen
- Department of Physical Medicine and Rehabilitation, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Medicine, Division of Physical Medicine and Rehabilitation, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Casey L Straud
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Willie J Hale
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Timothy T Houle
- Department of Anesthesia, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brett T Litz
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Donald B Penzien
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Terence M Keane
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.,National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Donald D McGeary
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA.,Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA
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Androulakis XM, Guo S, Zhang J, Sico J, Warren P, Giakas A, Li X, Peterlin BL, Mathew R, Reyes D. Suicide Attempts in US Veterans with Chronic Headache Disorders: A 10-Year Retrospective Cohort Study. J Pain Res 2021; 14:2629-2639. [PMID: 34466030 PMCID: PMC8403028 DOI: 10.2147/jpr.s322432] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/29/2021] [Indexed: 12/28/2022] Open
Abstract
Objectives A large-scale retrospective analysis of veterans with chronic pain was conducted to examine (1) the annual incidence of suicide attempts (SA) in veterans with chronic headache and other chronic pain conditions, and (2) the risk of SA in men and women with chronic headache and chronic headache concurrent with traumatic brain injury (TBI) as compared to non-headache chronic pain. Methods This retrospective study (N=3,247,621) analyzed National Veterans Affair Health Administrative data of patients diagnosed with chronic head, neck, back and other chronic pain from 2000 to 2010. Multivariable Poisson regression was used to explore the relative risks of SA in veterans with chronic headache and chronic headache concurrent with TBI as stratified by sex. Results Veterans with chronic headaches had the highest annual incidence of SA (329 to 491 per 100,000) each year among all identified types of chronic pain conditions. Compared to other non-headache chronic pain, chronic headache is associated with increased risk of SA [men RR (1.48), CI (1.37,1.59); women RR (1.64), CI (1.28,2.09)], after adjusting for demographic factors, TBI, and psychiatric comorbidities. The risk increased further when chronic headache is comorbid with TBI [men RR (2.82), CI (2.60, 3.05); women RR (2.16, CI (1.67-2.78)]. Conclusion Veterans with chronic headache have a higher risk of SA than those with other chronic pain and women with chronic headache are at a higher risk than men with chronic headache. Chronic headache concurrent with TBI further heightened this risk, especially in men. Our data underscore the importance of identifying specific types of chronic pain in veterans with comorbid TBI and sex disparity associated with SA when targeting suicide prevention measures.
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Affiliation(s)
- X Michelle Androulakis
- Department of Neurology, Columbia VA Healthcare System, Columbia, SC, USA.,Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,School of Medicine, University of South Carolina, Columbia, SC, USA.,Headache Centers of Excellence Program, US Department of Veterans Affairs, Columbia, SC, USA
| | - Siyuan Guo
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Jiajia Zhang
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Jason Sico
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA.,Headache Centers of Excellence Program, US Department of Veterans Affairs, West Haven, CT, USA
| | - Peter Warren
- Department of Neurology, Columbia VA Healthcare System, Columbia, SC, USA
| | - Alec Giakas
- School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | | | - Roy Mathew
- Department of Neurology, Columbia VA Healthcare System, Columbia, SC, USA.,School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Deborah Reyes
- Department of Neurology, Columbia VA Healthcare System, Columbia, SC, USA
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Jessen J, Özgül ÖS, Höffken O, Schwenkreis P, Tegenthoff M, Enax-Krumova EK. Somatosensory dysfunction in patients with posttraumatic headache: A systematic review. Cephalalgia 2021; 42:73-81. [PMID: 34404271 DOI: 10.1177/03331024211030496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Aim of the review is to summarize the knowledge about the sensory function and pain modulatory systems in posttraumatic headache and discuss its possible role in patients with posttraumatic headache. BACKGROUND Posttraumatic headache is the most common complication after traumatic brain injury, and significantly impacts patients' quality of life. Even though it has a high prevalence, its origin and pathophysiology are poorly understood. Thereby, the existing treatment options are insufficient. Identifying its mechanisms can be an important step forward to develop target-based personalized treatment. METHODS We searched the PubMed database for studies examining pain modulation and/or quantitative sensory testing in individuals with headache after brain injury. RESULTS The studies showed heterogenous alterations in sensory profiles (especially in heat and pressure pain perception) compared to healthy controls and headache-free traumatic brain injury-patients. Furthermore, pain inhibition capacity was found to be diminished in subjects with posttraumatic headache. CONCLUSIONS Due to the small number of heterogenous studies a distinct sensory pattern for patients with posttraumatic headache could not be identified. Further research is needed to clarify the underlying mechanisms and biomarkers for prediction of development and persistence of posttraumatic headache.
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Affiliation(s)
- Julia Jessen
- Department of Neurology, BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany
| | - Özüm S Özgül
- Department of Neurology, BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany
| | - Oliver Höffken
- Department of Neurology, BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany
| | - Peter Schwenkreis
- Department of Neurology, BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany
| | - Martin Tegenthoff
- Department of Neurology, BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany
| | - Elena K Enax-Krumova
- Department of Neurology, BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany
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Driver S, Douglas M, Reynolds M, McShan E, Swank C, Dubiel R. A narrative review of biopsychosocial factors which impact overweight and obesity for individuals with acquired brain injury. Brain Inj 2021; 35:1075-1085. [PMID: 34324396 DOI: 10.1080/02699052.2021.1953596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Primary Objective: To discuss the biopsychosocial factors that affect being overweight or obese after acquired brain injury (ABI)Research Design: Narrative reviewMethods and Procedures: Based on the biopsychosocial model, we discuss the unique injury-specific factors that can affect bring overweight or obese among individuals with ABI including: (1) biological, (2) psychological and (3) social/ecological factors.Main Outcomes and Results: Injury-specific factors that impact being overweight or obese following ABI include endocrine dysfunction, pain, bowel and bladder incontinence, balance problems and motor impairment, medications, sleep quality and fatigue, alcohol and tobacco use, psychological disorders and symptoms, cognitive changes, social support, isolation, participation, transportation, independence, and knowledge. These factors may also compound general factors impacting weight management, making it difficult for individuals with ABI to maintain a healthy lifestyle.Conclusions: It is important to recognize the biopsychosocial factors that impact weight-loss and lifestyle change after ABI so that interventions can be tailored to meet individuals' unique needs. Empirical research is needed to better understand how biopsychosocial factors interact and impact overweight/ obesity after ABI.
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Affiliation(s)
- Simon Driver
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, United States of America
| | - Megan Douglas
- Rehabilitation Research Department, Baylor Scott and White Research Institute, Dallas, Texas
| | - Megan Reynolds
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, United States of America
| | - Evan McShan
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, United States of America
| | - Chad Swank
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, United States of America
| | - Randi Dubiel
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, United States of America
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Hong P, Song YG, Paek S. Possible effects of agent orange and posttraumatic stress disorder on hyperglycemia in Korean veterans from the US-Vietnam war. Medicine (Baltimore) 2021; 100:e26508. [PMID: 34160471 PMCID: PMC8238358 DOI: 10.1097/md.0000000000026508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 05/12/2021] [Indexed: 01/04/2023] Open
Abstract
This study was conducted to examine whether Korean veterans from the US-Vietnam War who had a diagnosis of type II diabetes mellitus (T2DM) as well as past history of exposure to agent orange (AO) are vulnerable to hyperglycemia when receiving intra-articular corticosteroid injection (IACI) for pain relief.The current study included a total of 49 patients (n = 49) who received an injection of triamcinolone 20 or 40 mg to the shoulder under sonographic guidance or did that of dexamethasone 10 mg or triamcinolone 40 mg combined with dexamethasone 20 mg to the spine under fluoroscopic guidance. Their 7-day fasting blood glucose (FBG) levels were measured and then averaged, serving as baseline levels. This is followed by measurement of FBG levels for 14 days of IACI. Respective measurements were compared with baseline levels. The patients were also evaluated for whether there are increases in FBG levels depending on insulin therapy as well as HbA1c ≥ 7% or HbA1c < 7%.Overall, there were significant increases in FBG levels by 64.7 ± 42.5 mg/dL at 1 day of IACI from baseline (P < .05). HbA1c ≥ 7% and HbA1c < 7% showed increases in FBG levels by 106.1 ± 49.0 mg/dL and 46.5 ± 3.8 mg/dL, respectively, at 1 day of IACI from baseline (P < .05). In the presence and absence of insulin therapy, there were significant increases in them by 122.6 ± 48.7 mg/dL and 48.0 ± 20.4 mg/dL, respectively, at 1 day of IACI from baseline (P < .05). But there were decreases in them to baseline levels at 2 days of IACI.Clinicians should consider the possibility of hyperglycemia when using corticosteroids for relief of musculoskeletal pain in Korean veterans from the US-Vietnam War who had a history of exposure to AO.
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Affiliation(s)
- Pa Hong
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon
| | - Yun Gyu Song
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon
| | - Sungwoo Paek
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea
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Zirovich MD, Pangarkar SS, Manh C, Chen L, Vangala S, Elashoff DA, Izuchukwu IS. Botulinum Toxin Type A for the Treatment of Post-traumatic Headache: A Randomized, Placebo-Controlled, Cross-over Study. Mil Med 2021; 186:493-499. [PMID: 33241323 DOI: 10.1093/milmed/usaa391] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/10/2020] [Accepted: 09/17/2020] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Botulinum toxin type A (BoNT/A) is an approved treatment for chronic migraine and has been shown to be effective in reducing number, days, and severity of headache in other headache disorders. Whether botulinum toxin is a safe and effective treatment specifically for post-traumatic headache (PTH), however, is unknown. This study sought to determine whether treatment with BoNT/A improved symptoms of PTH in military veterans. MATERIALS AND METHODS Forty subjects with PTH were randomized to receive treatment of either BoNT/A or a saline placebo. Sixteen weeks post-treatment or at return to baseline headache severity, subjects were crossed over to receive treatment with the other medication than previously treated with in the first session. Subjects recorded number of headaches, number of headache days, and headache pain severity in daily diaries. Outcome measures included change in the weekly number of headaches, number of headache days per week, and headache pain severity compared to baseline, and the change in number of headaches and number of headaches days at baseline compared to the rating scores averaged across weeks 6-11. RESULTS The number of headaches per week significantly decreased by 2.24 (43.3%) with BoNT/A treatment (P < .001) and significantly increased by 1.28 (35.1%) with placebo (P = .02) at the end of the 16 weeks and the difference between groups was also significant (P < .001). The number of headache days per week also significantly decreased by 2.24 (44.4%) at the end of 16 weeks with BoNT/A treatment (P < .001), was not significantly changed with placebo, and the difference between the two groups was significant (P < .001). Both the change in number of headaches and number of headache days averaged across weeks 6-11 compared to baseline were significantly decreased in the BoNT/A group (1.6 and 1.4, respectively) compared to a significant increase of 0.3 in number of weekly headaches and a nonsignificant decrease of 0.1 in number of headache days for the placebo group (P = .048 and P = .005, respectively). Headache pain severity was significantly reduced by 0.06 with botulinum toxin treatment (P = .02) and was not significantly increased by 0.04 in the placebo group with a significant difference between groups (P = .006). CONCLUSIONS Treatment with BoNT/A clinically and significantly improved the frequency and pain severity of PTH compared to placebo in military veterans. Limitations of the study include subject dropout, adherence to documenting variables daily in the dairy, and only one treatment of BoNT/A. Strengths include the cross-over study design, which demonstrated that BoNT/A was effective regardless of treatment order. This dataset is the first prospective study to evaluate BoNT/A as an intervention for symptoms of PTH and provides evidence that larger-scale and multiple treatment studies evaluating BoNT/A for this headache type are warranted.
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Affiliation(s)
- Milena D Zirovich
- Physical Medicine and Rehabilitation Service, VA Greater Los Angeles Healthcare Service, Los Angeles, CA 90073, USA.,Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Sanjog S Pangarkar
- Physical Medicine and Rehabilitation Service, VA Greater Los Angeles Healthcare Service, Los Angeles, CA 90073, USA.,Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Christina Manh
- Physical Medicine and Rehabilitation Service, VA Greater Los Angeles Healthcare Service, Los Angeles, CA 90073, USA
| | - Lucia Chen
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA
| | - Sitaram Vangala
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA
| | - David A Elashoff
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA.,Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA 90095, USA.,Clinical Translational Science Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA
| | - Ifeoma Stella Izuchukwu
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA.,Internal Medicine Service, VA Greater Los Angeles Healthcare Service, Los Angeles, CA 90073, USA
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Abstract
Chronic posttraumatic headache (PTH) is among the most common and disabling sequelae of traumatic brain injury (TBI). Current PTH treatments are often only partially effective and have problematic side effects. We previously showed in a small randomized trial of patients with chronic nontraumatic headaches that manipulation of dietary fatty acids decreased headache frequency, severity, and pain medication use. Pain reduction was associated with alterations in oxylipins derived from n-3 and n-6 fatty acids, suggesting that oxylipins could potentially mediate clinical pain reduction. The objective of this study was to investigate whether circulating oxylipins measured in the acute setting after TBI could serve as prognostic biomarkers for developing chronic PTH. Participants enrolled in the Traumatic Head Injury Neuroimaging Classification Protocol provided serum within 3 days of TBI and were followed up at 90 days postinjury with a neurobehavioral symptom inventory (NSI) and satisfaction with life survey. Liquid chromatography-tandem mass spectrometry methods profiled 39 oxylipins derived from n-3 docosahexaenoic acid (DHA), and n-6 arachidonic acid and linoleic acid. Statistical analyses assessed the association of oxylipins with headache severity (primary outcome, measured by headache question on NSI) as well as associations between oxylipins and total NSI or satisfaction with life survey scores. Among oxylipins, 4-hydroxy-DHA and 19,20-epoxy-docosapentaenoate (DHA derivatives) were inversely associated with headache severity, and 11-hydroxy-9-epoxy-octadecenoate (a linoleic acid derivative) was positively associated with headache severity. These findings support a potential for DHA-derived oxylipins as prognostic biomarkers for development of chronic PTH.
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Amyot F, Lynch CE, Ollinger J, Werner JK, Silverman E, Moore C, Davis C, Turtzo LC, Diaz-Arrastia R, Kenney K. Cerebrovascular Reactivity Measures Are Associated With Post-traumatic Headache Severity in Chronic TBI; A Retrospective Analysis. Front Physiol 2021; 12:649901. [PMID: 34054569 PMCID: PMC8155500 DOI: 10.3389/fphys.2021.649901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/17/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To characterize the relationship between persistent post-traumatic headache (pPTH) and traumatic cerebrovascular injury (TCVI) in chronic traumatic brain injury (TBI). Cerebrovascular reactivity (CVR), a measure of the cerebral microvasculature and endothelial cell function, is altered both in individuals with chronic TBI and migraine headache disorder (Amyot et al., 2017; Lee et al., 2019b). The pathophysiologies of pPTH and migraine are believed to be associated with chronic microvascular dysfunction. We therefore hypothesize that TCVI may contribute to the underlying migraine-like mechanism(s) of pPTH. MATERIALS AND METHODS 22 moderate/severe TBI participants in the chronic stage (>6 months) underwent anatomic and functional magnetic resonance imaging (fMRI) scanning with hypercapnia gas challenge to measure CVR as well as the change in CVR (ΔCVR) after single-dose treatment of a specific phosphodiesterase-5 (PDE-5) inhibitor, sildenafil, which potentiates vasodilation in response to hypercapnia in impaired endothelium, as part of a Phase2a RCT of sildenafil in chronic TBI (NCT01762475). CVR and ΔCVR measures of each participant were compared with the individual's pPTH severity measured by the headache impact test-6 (HIT-6) survey. RESULTS There was a moderate correlation between HIT-6 and both CVR and ΔCVR scores [Spearman's correlation = -0.50 (p = 0.018) and = 0.46 (p = 0.03), respectively], indicating that a higher headache burden is associated with decreased endothelial function in our chronic TBI population. CONCLUSION There is a correlation between PTH and CVR in chronic moderate-severe TBI. This relationship suggests that chronic TCVI may underlie the pathobiology of pPTH. Further, our results suggest that novel treatment strategies that target endothelial function and vascular health may be beneficial in refractory pPTH.
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Affiliation(s)
- Franck Amyot
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Cillian E. Lynch
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - John Ollinger
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - J. Kent Werner
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - E. Silverman
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Carol Moore
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Cora Davis
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - L. Christine Turtzo
- National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Ramon Diaz-Arrastia
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Kimbra Kenney
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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fMRI findings in MTBI patients with headaches following rTMS. Sci Rep 2021; 11:9573. [PMID: 33953315 PMCID: PMC8100290 DOI: 10.1038/s41598-021-89118-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/15/2021] [Indexed: 11/15/2022] Open
Abstract
Mild Traumatic Brain Injury (MTBI) patients with persistent headaches are known to have diminished supraspinal modulatory connectivity from their prefrontal cortices. Repetitive transcranial magnetic stimulation (rTMS) is able to alleviate MTBI-related headache (MTBI-HA). This functional magnetic resonance imaging (fMRI) study assessed supraspinal correlates associated with the headache analgesic effect of rTMS at left prefrontal cortex (LPFC), hypothesizing real rTMS would significantly increase modulatory functions at LPFC in comparison to sham treatment. Subjects with MTBI-HA were randomized to receive either real or sham rTMS treatments and subjected to pre- and post-treatment resting state and evoked heat-pain fMRI as described in a prior study. Real rTMS consisted of 2000 pulses delivered at 10 Hz and 80% of the resting motor threshold at left dorsolateral prefrontal cortex, whereas sham treatment was delivered with same figure-of-eight coil turned 180 degrees. Follow-up fMRI was performed one-week post-treatment.
All fMRI data was processed using BrainVoyager QX Software. 14 subjects receiving real and 12 subjects receiving sham treatments completed the study. The REAL group demonstrated significant (P < 0.02) decreases in headache frequency and intensity at one week following treatment. fMRI scans in the REAL group showed increased evoked heat pain activity (P < 0.002) and resting functional connectivity (P < 0.0001) at the LPFC after rTMS. Neither this significant analgesic effect nor these fMRI findings were seen in the sham group. Sham treatment was, however, associated with a decrease in resting state activity at the LPFC (P < 0.0001). This study correlates the demonstrated analgesic effect of rTMS in the treatment of MTBI-HA with enhanced supraspinal functional connectivity in the left prefrontal cortex, which is known to be involved in “top-down” pain inhibition along the descending midbrain-thalamic-cingulate pathway.
Trial Registration: This study was registered on September 24, 2013, on ClinicalTrials.gov with the identifier: NCT01948947. https://clinicaltrials.gov/ct2/show/NCT01948947.
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Cortez MM, Millsap L, Rea NA, Sciarretta C, Brennan KC. Photophobia and allodynia in persistent post-traumatic headache are associated with higher disease burden. Cephalalgia 2021; 41:1089-1099. [PMID: 33910382 DOI: 10.1177/03331024211010304] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess photophobia and allodynia in subjects with post-traumatic headache and examine how these sensory hypersensitivities associate with clinical measures of disease burden. BACKGROUND Post-traumatic headache is the most frequent and disabling long-term consequence of mild traumatic brain injury. There is evidence of sensory dysfunction in acute post-traumatic headache, and it is known from other headache conditions that sensory amplifications correlate with more severe disease. However, systematic studies in post-traumatic headache are surprisingly scarce. METHODS We tested light and tactile sensitivity, along with measures of disease burden, in 30 persistent post-traumatic headache subjects and 35 controls. RESULTS In all, 79% of post-traumatic headache subjects exhibited sensory hypersensitivity based on psychophysical assessment. Of those exhibiting hypersensitivity, 54% exhibited both light and tactile sensitivity. Finally, sensory thresholds were correlated across modalities, as well as with headache attack frequency. CONCLUSIONS In this study, post-traumatic headache subjects with both light and tactile sensitivity had significantly higher headache frequencies and lower sensitivity thresholds to both modalities, compared to those with single or no sensory hypersensitivity. This pattern suggests that hypersensitivity across multiple modalities may be functionally synergistic, reflect a higher disease burden, and may serve as candidate markers of disease.
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Affiliation(s)
- Melissa M Cortez
- University of Utah, Department of Neurology, Salt Lake City, UT, USA
| | - Leah Millsap
- University of Utah, Department of Neurology, Salt Lake City, UT, USA
| | - Natalie A Rea
- University of Utah, School of Medicine, Salt Lake City, UT, USA.,Mayo Clinic, Rochester, MN, USA
| | | | - K C Brennan
- University of Utah, Department of Neurology, Salt Lake City, UT, USA
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Burrowes SAB, Rhodes CS, Meeker TJ, Greenspan JD, Gullapalli RP, Seminowicz DA. Decreased grey matter volume in mTBI patients with post-traumatic headache compared to headache-free mTBI patients and healthy controls: a longitudinal MRI study. Brain Imaging Behav 2021; 14:1651-1659. [PMID: 30980274 DOI: 10.1007/s11682-019-00095-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Traumatic brain injury (TBI) occurs in 1.7 million people annually and many patients go on to develop persistent disorders including post-traumatic headache (PTH). PTH is considered chronic if it continues past 3 months. In this study we aimed to identify changes in cerebral grey matter volume (GMV) associated with PTH in mild TBI patients. 50 mTBI patients (31 Non-PTH; 19 PTH) underwent MRI scans: within 10 days post-injury, 1 month, 6 months and 18 months. PTH was assessed at visit 4 by a post-TBI headache questionnaire. Healthy controls (n = 21) were scanned twice 6 months apart. Compared to non-PTH, PTH patients had decreased GMV across two large clusters described as the right anterior-parietal (p = 0.012) and left temporal-opercular (p = 0.027). Compared to healthy controls non-PTH patients had decreased GMV in the left thalamus (p = 0.047); PTH patients had decreased GMV in several extensive clusters: left temporal-opercular (p = 0.003), temporal-parietal (p = 0.041), superior frontal gyrus (p = 0.008) and right middle frontal/superior frontal gyrus (0.004) and anterior-parietal (p = 0.003). Differences between PTH and non-PTH patients were most striking at early time points. These early changes may be associated with an increased risk of PTH. Patients with these changes should be monitored for chronic PTH.
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Affiliation(s)
- Shana A B Burrowes
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA.,Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, 650 W. Baltimore Street, 8 South, Baltimore, MD, 21201, USA.,Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA
| | - Chandler Sours Rhodes
- Diagnostic Radiology and Nuclear Medicine, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA
| | - Timothy J Meeker
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, 650 W. Baltimore Street, 8 South, Baltimore, MD, 21201, USA
| | - Joel D Greenspan
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, 650 W. Baltimore Street, 8 South, Baltimore, MD, 21201, USA.,Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA
| | - Rao P Gullapalli
- Diagnostic Radiology and Nuclear Medicine, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA
| | - David A Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, 650 W. Baltimore Street, 8 South, Baltimore, MD, 21201, USA. .,Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA.
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McGeary DD, Penzien DB, Resick PA, McGeary CA, Jaramillo CA, Eapen BC, Young-McCaughan S, Nabity PS, Moring JC, Houle TT, Keane TM, Peterson AL. Study design for a randomized clinical trial of cognitive-behavioral therapy for posttraumatic headache. Contemp Clin Trials Commun 2021; 21:100699. [PMID: 33490706 PMCID: PMC7806520 DOI: 10.1016/j.conctc.2021.100699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/06/2020] [Accepted: 01/01/2021] [Indexed: 11/29/2022] Open
Abstract
Posttraumatic headache (PTH) is a common debilitating condition arising from head injury and is highly prevalent among military service members and veterans with traumatic brain injury (TBI). Diagnosis and treatment for PTH is still evolving, and surprisingly little is known about the putative mechanisms that drive these headaches. This manuscript describes the design of a randomized clinical trial of two nonpharmacological (i.e., behavioral) interventions for posttraumatic headache. Design of this trial required careful consideration of PTH diagnosis and inclusion criteria, which was challenging due to the lack of standard clinical characteristics in PTH unique from other types of headaches. The treatments under study differed in clinical focus and dose (i.e., number of treatment sessions), but the trial was designed to balance the treatments as well as possible. Finally, while the primary endpoints for pain research can vary from assessments of pain intensity to objective and subjective functional measures, this trial of PTH interventions chose carefully to establish clinically relevant endpoints and to maximize the opportunity to detect significant differences between groups with two primary outcomes. All these issues are discussed in this manuscript.
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Key Words
- AUDIT, Alcohol Use Disorders Identification Test-Self Report
- B-IPF, Brief Inventory of Psychosocial Functioning
- CAP, Consortium to Alleviate PTSD
- CAPS-5, Clinician-Administered PTSD Scale for DSM-5
- CBT, cognitive-behavioral therapy
- CCBT, clinic-based cognitive-behavioral therapy intervention for headache
- CEQ, Credibility and Expectancy Questionnaire
- CGRP, calcitonin gene-related peptide
- CPRS, Computerized Patient Record System
- CPT, Cognitive Processing Therapy
- CRIS, Community Reintegration of Injured Service Members
- DRRI-2-D, Deployment Risk and Resilience Inventory-2-Deployment Environment
- DRRI-2-P, Deployment Risk and Resilience Inventory-Postbattle Experiences
- DSI-SS, Depressive Symptom Index-Suicide Subscale
- DoD, U.S. Department of Defense
- GAD-7, Generalized Anxiety Disorder Screener
- GLM, general linear mixed
- HIPAA, Health Insurance Portability and Accountability Act
- HIT-6, Headache Impact Test
- HMSE, Headache Management Self-Efficacy Scale
- HSLC, Headache-Specific Locus of Control Scale
- Headache
- ICHD-2, International Classification of Headache Disorders, 2nd Edition
- ICHD-3, International Classification of Headache Disorders, 3rd Edition
- IRB, institutional review board
- ISI, Insomnia Severity Index
- ITT, intent to treat
- LEC-5, Life Events Checklist for DSM-5
- NIH, National Institutes of Health
- NSI, Neurobehavioral Symptom Inventory
- OSU TBI-ID-SF, Ohio State University TBI Identification Method-Interview Form
- PCL-5, PTSD Checklist for DSM-5
- PHQ-15, Patient Health Questionnaire-15
- PHQ-9, Patient Health Questionnaire-9 Item
- PP, per protocol
- PRC, Polytrauma Rehabilitation Center
- PROMIS, Patient-Reported Outcomes Measurement Information System
- PTCI, Posttraumatic Cognitions Inventory
- PTH, posttraumatic headache
- PTHA Study, posttraumatic headache and PTSD study
- PTSD
- PTSD, posttraumatic stress disorder
- Polymorbidity
- QDS, Quick Drinking Screen
- RSES, Response to Stressful Experiences Scale
- SDIH-R, Structured Diagnostic Interview for Headache-Revised, Brief Version
- SITBI, Self-Injurious Thoughts and Behaviors Interview – Short Form
- STOP, Snoring, Tired, Observed, Blood Pressure
- TAU, treatment as usual
- TBI, traumatic brain injury
- Traumatic brain injury
- VA, U.S. Department of Veterans Affairs
- VHCS, Veterans Health Care System
- VR-12, Veterans RAND 12-Item Health Survey
- Veterans
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Affiliation(s)
- Donald D. McGeary
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
- Department of Rehabilitation Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Donald B. Penzien
- Departments of Psychiatry and Behavioral Medicine & Neurology, Wake Forest University, Winston-Salem, NC, USA
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Cindy A. McGeary
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Carlos A. Jaramillo
- South Texas Veterans Health Care System, San Antonio, TX, USA
- Department of Rehabilitation Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Blessen C. Eapen
- Greater Los Angeles Veterans Health Care System, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California, Los Angeles, PM&R, Los Angeles, CA, USA
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Paul S. Nabity
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - John C. Moring
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Timothy T. Houle
- Department of Anaesthesia, Massachusetts General Hospital, Boston, MA, USA
| | - Terence M. Keane
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Alan L. Peterson
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
- Department of Psychology, The University of Texas at San Antonio, San Antonio, TX, USA
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Kopruszinski CM, Turnes JM, Swiokla J, Weinstein TJ, Schwedt TJ, Dodick DW, Anderson T, Navratilova E, Porreca F. CGRP monoclonal antibody prevents the loss of diffuse noxious inhibitory controls (DNIC) in a mouse model of post-traumatic headache. Cephalalgia 2021; 41:749-759. [PMID: 33615840 DOI: 10.1177/0333102420981688] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM Determine the role of calcitonin-gene related peptide in promoting post-traumatic headache and dysregulation of central pain modulation induced by mild traumatic brain injury in mice. METHODS Mild traumatic brain injury was induced in lightly anesthetized male C57BL/6J mice by a weight drop onto a closed and unfixed skull, which allowed free head rotation after the impact. We first determined possible alterations in the diffuse noxious inhibitory controls, a measure of net descending pain inhibition called conditioned pain modulation in humans at day 2 following mild traumatic brain injury. Diffuse noxious inhibitory control was assessed as the latency to a thermally induced tail-flick that served as the test stimulus in the presence of right forepaw capsaicin injection that provided the conditioning stimulus. Post-traumatic headache-like behaviors were assessed by the development of cutaneous allodynia in the periorbital and hindpaw regions after mild traumatic brain injury. We then determined if intraperitoneal fremanezumab, an anti-calcitonin-gene related peptide monoclonal antibody or vehicle administered 2 h after sham or mild traumatic brain injury induction could alter cutaneous allodynia or diffuse noxious inhibitory control responses on day 2 post mild traumatic brain injury. RESULTS In naïve and sham mice, capsaicin injection into the forepaw elevated the latency to tail-flick, reflecting the antinociceptive diffuse noxious inhibitory control response. Periorbital and hindpaw cutaneous allodynia, as well as a loss of diffuse noxious inhibitory control, was observed in mice 2 days after mild traumatic brain injury. Systemic treatment with fremanezumab blocked mild traumatic brain injury-induced cutaneous allodynia and prevented the loss of diffuse noxious inhibitory controls in mice subjected to a mild traumatic brain injury. INTERPRETATION Sequestration of calcitonin-gene related peptide in the initial stages following mild traumatic brain injury blocked the acute allodynia that may reflect mild traumatic brain injury-related post-traumatic headache and, additionally, prevented the loss of net descending inhibition within central pain modulation pathways. As loss of conditioned pain modulation has been linked to multiple persistent pain conditions, dysregulation of descending modulatory pathways may contribute to the persistence of post-traumatic headache. Additionally, evaluation of the conditioned pain modulation/diffuse noxious inhibitory controls response may serve as a biomarker of vulnerability for chronic/persistent pain. These findings suggest that early anti-calcitonin-gene related peptide intervention has the potential to be effective both for the treatment of mild traumatic brain injury-induced post-traumatic headache, as well as inhibiting mechanisms that may promote post-traumatic headache persistence.
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Affiliation(s)
- Caroline M Kopruszinski
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Joelle M Turnes
- Department of Pharmacology, Federal University of Parana, Curitiba, Parana, Brazil
| | - Juliana Swiokla
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Troy J Weinstein
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | | | | | - Trent Anderson
- Department of Biomedical Sciences, College of Medicine, University of Arizona, Phoenix, AZ, USA
| | - Edita Navratilova
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Frank Porreca
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, Arizona, USA.,Department of Neurology, Mayo Clinic, Phoenix, AZ, USA
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Flowers M, Leung A, Schiehser DM, Metzger-Smith V, Delano-Wood L, Sorg S, Kunnel A, Wong A, Vaninetti M, Golshan S, Lee R. Severities in persistent mild traumatic brain injury related headache is associated with changes in supraspinal pain modulatory functions. Mol Pain 2021; 17:17448069211037881. [PMID: 34365850 PMCID: PMC8358489 DOI: 10.1177/17448069211037881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/04/2021] [Accepted: 07/19/2021] [Indexed: 11/17/2022] Open
Abstract
Emerging evidence suggests mild traumatic brain injury related headache (MTBI-HA) is a form of neuropathic pain state. Previous supraspinal mechanistic studies indicate patients with MTBI-HA demonstrate a dissociative state with diminished levels of supraspinal prefrontal pain modulatory functions and enhanced supraspinal sensory response to pain in comparison to healthy controls. However, the relationship between supraspinal pain modulatory functional deficit and severity of MTBI-HA is largely unknown. Understanding this relationship may provide enhanced levels of insight about MTBI-HA and facilitate the development of treatments. This study assessed pain related supraspinal resting states among MTBI-HA patients with various headache intensity phenotypes with comparisons to controls via functional magnetic resonance imaging (fMRI). Resting state fMRI data was analyzed with self-organizing-group-independent-component-analysis in three MTBI-HA intensity groups (mild, moderate, and severe) and one control group (n = 16 per group) within a pre-defined supraspinal pain network based on prior studies. In the mild-headache group, significant increases in supraspinal function were observed in the right premotor cortex (T = 3.53, p < 0.001) and the left premotor cortex (T = 3.99, p < 0.0001) when compared to the control group. In the moderate-headache group, a significant (T = -3.05, p < 0.01) decrease in resting state activity was observed in the left superior parietal cortex when compared to the mild-headache group. In the severe-headache group, significant decreases in resting state supraspinal activities in the right insula (T = -3.46, p < 0.001), right premotor cortex (T = -3.30, p < 0.01), left premotor cortex (T = -3.84, p < 0.001), and left parietal cortex (T = -3.94, p < 0.0001), and an increase in activity in the right secondary somatosensory cortex (T = 4.05, p < 0.0001) were observed when compared to the moderate-headache group. The results of the study suggest that the increase in MTBI-HA severity may be associated with an imbalance in the supraspinal pain network with decline in supraspinal pain modulatory function and enhancement of sensory/pain decoding.
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Affiliation(s)
- Matthew Flowers
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Albert Leung
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Anesthesiology, The University of California, San Diego, La Jolla, CA, USA
| | - Dawn M Schiehser
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, The University of California, San Diego, La Jolla, CA, USA
| | - Valerie Metzger-Smith
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Lisa Delano-Wood
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, The University of California, San Diego, La Jolla, CA, USA
| | - Scott Sorg
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, The University of California, San Diego, La Jolla, CA, USA
| | - Alphonsa Kunnel
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Angeline Wong
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Michael Vaninetti
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Anesthesiology, The University of California, San Diego, La Jolla, CA, USA
| | - Shahrokh Golshan
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Roland Lee
- Department of Radiology, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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40
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McGlennon TW, Buchwald JN, Pories WJ, Yu F, Roberts A, Ahnfeldt EP, Menon R, Buchwald H. Bypassing TBI: Metabolic Surgery and the Link between Obesity and Traumatic Brain Injury-a Review. Obes Surg 2020; 30:4704-4714. [PMID: 33125676 DOI: 10.1007/s11695-020-05065-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 12/14/2022]
Abstract
Obesity is a common outcome of traumatic brain injury (TBI) that exacerbates principal TBI symptom domains identified as common areas of post-TBI long-term dysfunction. Obesity is also associated with increased risk of later-life dementia and Alzheimer's disease. Patients with obesity and chronic TBI may be more vulnerable to long-term mental abnormalities. This review explores the question of whether weight loss induced by bariatric surgery could delay or perhaps even reverse the progression of mental deterioration. Bariatric surgery, with its induction of weight loss, remission of type 2 diabetes, and other expressions of the metabolic syndrome, improves metabolic efficiency, leads to reversal of brain lesions seen on imaging studies, and improves function. These observations suggest that metabolic/bariatric surgery may be a most effective therapy for TBI.
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Affiliation(s)
- T W McGlennon
- Statistics Division, McGlennon MotiMetrics, Maiden Rock, WI, USA
| | - J N Buchwald
- Division of Scientific Research Writing, Medwrite, Maiden Rock, WI, USA
| | - Walter J Pories
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | | | - Eric P Ahnfeldt
- Uniformed Services University of the Health Sciences, Bethesda, MA, USA
| | - Rukmini Menon
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Henry Buchwald
- Surgery and Biomedical Engineering, Owen H. & Sarah Davidson Wangensteen Chair in Experimental Surgery, Emeritus, University of Minnesota Medical School, 420 Delaware Street SE, MMC 195, Minneapolis, MN, 55455, USA.
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McGeary DD, Resick PA, Penzien DB, Eapen BC, Jaramillo C, McGeary CA, Nabity PS, Peterson AL, Young-McCaughan S, Keane TM, Reed D, Moring J, Sico JJ, Pangarkar SS, Houle TT. Reason to doubt the ICHD-3 7-day inclusion criterion for mild TBI-related posttraumatic headache: A nested cohort study. Cephalalgia 2020; 40:1155-1167. [DOI: 10.1177/0333102420953109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Posttraumatic headache is difficult to define and there is debate about the specificity of the 7-day headache onset criterion in the current definition. There is limited evidence available to guide decision making about this criterion. Method A nested cohort study of 193 treatment-seeking veterans who met criteria for persistent headache attributed to mild traumatic injury to the head, including some veterans with delayed headache onset up to 90 days post-injury, was undertaken. Survival analysis examined the proportion of participants reporting headache over time and differences in these proportions based on sex, headache phenotype, and mechanism of injury. Result 127 participants (66%; 95% CI: 59–72%) reported headache onset within 7 days of head injury and 65 (34%) reported headache onset between 8 days and 3 months after head injury. Fourteen percent of participants reported pre-existing migraine before head injury, and there was no difference in the proportion of veterans with pre-existing migraine based on headache onset. Headache onset times were not associated with sex, headache phenotype, or mechanism of injury. There were no significant differences in proportion of veterans with headache onset within 7 days of head injury based on headache phenotype (70% migraine onset within 7 days, 70% tension-type headache within 7 days, 56% cluster headache within 7 days; p ≥ .364). Similar findings were observed for head injury (64% blast, 60% blunt; p = .973). There were no significant differences observed between headache onset groups for psychiatric symptoms (Posttraumatic Stress Disorder Checklist for DSM-5 = 1.3, 95% CI = −27.5, 30.1; Patient Health Questionnaire-9 Item = 3.5, 95% CI = −6.3, 3.7; Generalized Anxiety Disorder Screener = 6.5, 95% CI = −2.7, 15.6). Conclusions Although most of the sample reported headache onset within 7 days of head injury, one-third experienced an onset outside of the diagnostic range. Additionally, veterans with headache onset within 7 days of head injury were not meaningfully different from those with later onset based on sex, headache phenotype, or mechanism of head injury. The ICHD-3 diagnostic criteria for 7-day headache onset should be expanded to 3 months. ClinicalTrials.gov Identifier NCT02419131
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Affiliation(s)
- Donald D McGeary
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
- Department of Rehabilitation Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Patricia A Resick
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Donald B Penzien
- Departments of Psychiatry and Behavioral Medicine & Neurology, Wake Forest University, Winston-Salem, NC, USA
| | - Blessen C Eapen
- Greater Los Angeles Veterans Health Care System, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California, Physical Medicine & Rehabilitation, Los Angeles, CA, USA
| | - Carlos Jaramillo
- Department of Rehabilitation Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Cindy A McGeary
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Paul S Nabity
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
- Department of Psychology, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Terence M Keane
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - David Reed
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - John Moring
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Jason J Sico
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Headache Center of Excellence, VA Connecticut Healthcare System, New Haven, CT, USA
| | - Sanjog S Pangarkar
- Greater Los Angeles Veterans Health Care System, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California, Physical Medicine & Rehabilitation, Los Angeles, CA, USA
| | - Timothy T Houle
- Department of Anaesthesia, Massachusetts General Hospital, Boston, MA, USA
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Usmani S, Balcer L, Galetta S, Minen M. Feasibility of Smartphone-Delivered Progressive Muscle Relaxation in Persistent Post-Traumatic Headache Patients. J Neurotrauma 2020; 38:94-101. [PMID: 32484070 DOI: 10.1089/neu.2019.6601] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Persistent post-traumatic headache (PPTH) is often the most common injury after mild traumatic brain injury (mTBI), reported by 47-95% of patients. Progressive muscle relaxation (PMR) has level A evidence in preventing migraine and tension headaches. However, research on this behavioral therapy for PPTH, let alone smartphone delivered, is limited. We performed a single-arm study of prospective patients calling our Concussion Center between June 2017 and July 2018. Inclusion criteria were that subjects had to meet International Classification of Headache Disorders, 3rd Edition criteria for PPTH secondary to mTBI, have four or more headache days a month, be age 18-85 years and 3-12 months post-injury, own a smartphone, and not tried headache behavioral therapy within the year. We recorded baseline headache and neuropsychiatric data. Using the RELAXaHEAD smartphone application, which has a headache diary and PMR audio files, participants were instructed to record headache symptoms and practice 20 min of PMR daily. There were three monthly follow-up assessments. There were 49 subjects enrolled. Basic demographics were: 33 (67%) female with mean age 40.1 ± 14.6 [20, 75] years. Of the 49 subjects, 15 (31%) had pre-existing headaches. In 11 (22%) subjects, mTBI was sports related. Subjects reported 17.7 ± 9.3 [4, 31] headache days in the month before enrollment, and 49 (100%) experienced over three concussion symptoms. Participants inputted data in the RELAXaHEAD app on average 18.3 ± 12.0 days [0, 31] the first month. Number of participants who did PMR over four times per week was 12 (24.5%) the first month, 9 (22.5%) the second month, and 6 (15%) the third month. After 3 months, 17 (42.5 %) participants continued doing PMR. Participants cited time constraints, forgetfulness, application glitches, and repetitiveness as obstacles to practicing PMR. It is feasible to get PPTH subjects to practice behavioral therapy through low-cost smartphone-based PMR two times weekly. Future work will assess efficacy and examine how to optimize barriers to PMR.
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Affiliation(s)
- Saima Usmani
- Department of Neurology, NYU Langone Medical Center, New York, New York, USA
| | - Laura Balcer
- Department of Neurology, NYU Langone Medical Center, New York, New York, USA
| | - Steven Galetta
- Department of Neurology, NYU Langone Medical Center, New York, New York, USA
| | - Mia Minen
- Department of Neurology, NYU Langone Medical Center, New York, New York, USA
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Tageldeen MK, Gowers SAN, Leong CL, Boutelle MG, Drakakis EM. Traumatic brain injury neuroelectrochemical monitoring: behind-the-ear micro-instrument and cloud application. J Neuroeng Rehabil 2020; 17:114. [PMID: 32825829 PMCID: PMC7441655 DOI: 10.1186/s12984-020-00742-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 08/04/2020] [Indexed: 01/15/2023] Open
Abstract
Background Traumatic Brain Injury (TBI) is a leading cause of fatality and disability worldwide, partly due to the occurrence of secondary injury and late interventions. Correct diagnosis and timely monitoring ensure effective medical intervention aimed at improving clinical outcome. However, due to the limitations in size and cost of current ambulatory bioinstruments, they cannot be used to monitor patients who may still be at risk of secondary injury outside the ICU. Methods We propose a complete system consisting of a wearable wireless bioinstrument and a cloud-based application for real-time TBI monitoring. The bioinstrument can simultaneously record up to ten channels including both ECoG biopotential and neurochemicals (e.g. potassium, glucose and lactate), and supports various electrochemical methods including potentiometry, amperometry and cyclic voltammetry. All channels support variable gain programming to automatically tune the input dynamic range and address biosensors’ falling sensitivity. The instrument is flexible and can be folded to occupy a small space behind the ear. A Bluetooth Low-Energy (BLE) receiver is used to wirelessly connect the instrument to a cloud application where the recorded data is stored, processed and visualised in real-time. Bench testing has been used to validate device performance. Results The instrument successfully monitored spreading depolarisations (SDs) - reproduced using a signal generator - with an SNR of 29.07 dB and NF of 0.26 dB. The potentiostat generates a wide voltage range from -1.65V to +1.65V with a resolution of 0.8mV and the sensitivity of the amperometric AFE was verified by recording 5 pA currents. Different potassium, glucose and lactate concentrations prepared in lab were accurately measured and their respective working curves were constructed. Finally,the instrument achieved a maximum sampling rate of 1.25 ksps/channel with a throughput of 105 kbps. All measurements were successfully received at the cloud. Conclusion The proposed instrument uniquely positions itself by presenting an aggressive optimisation of size and cost while maintaining high measurement accuracy. The system can effectively extend neuroelectrochemical monitoring to all TBI patients including those who are mobile and those who are outside the ICU. Finally, data recorded in the cloud application could be used to help diagnosis and guide rehabilitation.
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Affiliation(s)
- Momen K Tageldeen
- Bioinspired VLSI Circuits and Systems Group, Department of Bioengineering, Imperial College London, Exhibition Road, London, SW7 2AZ, UK
| | - Sally A N Gowers
- Biomedical Sensors Group, Department of Bioengineering, Imperial College London, Exhibition Road, London, SW7 2AZ, UK
| | - Chi L Leong
- Biomedical Sensors Group, Department of Bioengineering, Imperial College London, Exhibition Road, London, SW7 2AZ, UK
| | - Martyn G Boutelle
- Biomedical Sensors Group, Department of Bioengineering, Imperial College London, Exhibition Road, London, SW7 2AZ, UK
| | - Emmanuel M Drakakis
- Bioinspired VLSI Circuits and Systems Group, Department of Bioengineering, Imperial College London, Exhibition Road, London, SW7 2AZ, UK.
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VanderEnde J, Bateman EA, MacKenzie HM, Sequeira K. Use of CGRP receptor blocker erenumab in the management of post-traumatic headache: a case series of 5 women. Brain Inj 2020; 34:1431-1434. [PMID: 32790533 DOI: 10.1080/02699052.2020.1807052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
CONTEXT Post-traumatic headache (PTH) is a disabling headache disorder and the most common sequela of mild traumatic brain injury. The pathophysiology of PTH is poorly understood and there is limited available evidence to guide prophylactic medication selection. Emerging understanding of the pathophysiology of migraine headaches has led to the development of monoclonal antibodies, including erenumab. Erenumab has shown promise for the prevention of primary migraine headache; however, it has not yet been studied in PTH. CASE SERIES five women (average age 43.0 ± 17.9y) received treatment with erenumab for PTH secondary to mTBI. The average duration of PTH prior to starting erenumab was 32.0 ± 18.2 months. All patients were taking at least one daily headache prophylactic therapy prior to erenumab. The average pre-erenumab headache intensity was 86/100. On erenumab, the average reported reduction in headache intensity was 51.1%. After starting erenumab, all five patients were able to discontinue one or more medication(s). The most common side effect was constipation (three patients). There were no serious adverse events after an average follow-up of 3.4 ± 1.5 months. One patient discontinued erenumab during this period of follow-up after the resolution of her headaches. CONCLUSION Erenumab appears to be safe and effective for the management of PTH.
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Affiliation(s)
- Jordan VanderEnde
- Department of Physical Medicine & Rehabilitation, Western University , London, Canada
| | - Emma A Bateman
- Department of Physical Medicine & Rehabilitation, Western University , London, Canada
| | - Heather M MacKenzie
- Department of Physical Medicine & Rehabilitation, Western University , London, Canada
| | - Keith Sequeira
- Department of Physical Medicine & Rehabilitation, Western University , London, Canada
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Leung A. Addressing chronic persistent headaches after MTBI as a neuropathic pain state. J Headache Pain 2020; 21:77. [PMID: 32560626 PMCID: PMC7304149 DOI: 10.1186/s10194-020-01133-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/25/2020] [Indexed: 12/15/2022] Open
Abstract
An increasing number of patients with chronic persistent post-traumatic headache (PPTH) after mild traumatic brain injury (MTBI) are being referred to headache or pain specialists as conventional treatment options for primary headache disorders have not been able to adequately alleviate their debilitating headache symptoms. Evolving clinical and mechanistic evidences support the notation that chronic persistent MTBI related headaches (MTBI-HA) carry the hallmark characteristics of neuropathic pain. Thus, in addition to conventional treatment options applicable to non-traumatic primary headache disorders, other available treatment modalities for neuropathic pain should be considered. In this comprehensive review article, the author reveals the prevalence of MTBI-HA and its clinical manifestation, discusses existing clinical and mechanistic evidence supporting the classification of chronic persistent MTBI-HA as a neuropathic pain state, and explores current available treatment options and future directions of therapeutic research related to MTBI-HA.
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Affiliation(s)
- Albert Leung
- Department of Anesthesiology, Center for Pain Medicine, UCSD School of Medicine, La Jolla, USA.
- Center for Pain and Headache Research, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92126, USA.
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Grangeon L, O'Connor E, Chan CK, Akijian L, Pham Ngoc TM, Matharu MS. New insights in post-traumatic headache with cluster headache phenotype: a cohort study. J Neurol Neurosurg Psychiatry 2020; 91:572-579. [PMID: 32381638 PMCID: PMC7279192 DOI: 10.1136/jnnp-2019-322725] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To define the characteristics of post-traumatic headache with cluster headache phenotype (PTH-CH) and to compare these characteristics with primary CH. METHODS A retrospective study was conducted of patients seen between 2007 and 2017 in a headache centre and diagnosed with PTH-CH that developed within 7 days of head trauma. A control cohort included 553 patients with primary CH without any history of trauma who attended the headache clinic during the same period. Data including demographics, attack characteristics and response to treatments were recorded. RESULTS Twenty-six patients with PTH-CH were identified. Multivariate analysis revealed significant associations between PTH-CH and family history of CH (OR 3.32, 95% CI 1.31 to 8.63), chronic form (OR 3.29, 95% CI 1.70 to 6.49), parietal (OR 14.82, 95% CI 6.32 to 37.39) or temporal (OR 2.04, 95% CI 1.10 to 3.84) location of pain, and presence of prominent cranial autonomic features during attacks (miosis OR 11.24, 95% CI 3.21 to 41.34; eyelid oedema OR 5.79, 95% CI 2.57 to 13.82; rhinorrhoea OR 2.65, 95% CI 1.26 to 5.86; facial sweating OR 2.53, 95% CI 1.33 to 4.93). Patients with PTH-CH were at a higher risk of being intractable to acute (OR 12.34, 95% CI 2.51 to 64.73) and preventive (OR 16.98, 95% CI 6.88 to 45.52) treatments and of suffering from associated chronic migraine (OR 10.35, 95% CI 3.96 to 28.82). CONCLUSION This largest series of PTH-CH defines it as a unique entity with specific evolutive profile. Patients with PTH-CH are more likely to suffer from the chronic variant, have marked autonomic features, be intractable to treatment and have associated chronic migraine compared with primary CH.
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Affiliation(s)
- Lou Grangeon
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, London, UK.,Department of Neurology, University Hospital Centre Rouen, Rouen, Normandie, France
| | - Emer O'Connor
- Department of Molecular Neuroscience, UCL Queen Square Institute of Neurology, London, UK
| | - Chun-Kong Chan
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, London, UK
| | - Layan Akijian
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, London, UK
| | - Thanh Mai Pham Ngoc
- Mathematics Institute of Orsay, Paris-Sud University, CNRS and Paris-Saclay University, Orsay, Île-de-France, France
| | - Manjit Singh Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, London, UK .,Headache and Facial Pain Group, The National Hospital for Neurology and Neurosurgery, London, UK
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Labastida-Ramírez A, Benemei S, Albanese M, D’Amico A, Grillo G, Grosu O, Ertem DH, Mecklenburg J, Fedorova EP, Řehulka P, di Cola FS, Lopez JT, Vashchenko N, MaassenVanDenBrink A, Martelletti P. Persistent post-traumatic headache: a migrainous loop or not? The clinical evidence. J Headache Pain 2020; 21:55. [PMID: 32448142 PMCID: PMC7245945 DOI: 10.1186/s10194-020-01122-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/05/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Headache is a common complication of traumatic brain injury. The International Headache Society defines post-traumatic headache as a secondary headache attributed to trauma or injury to the head that develops within seven days following trauma. Acute post-traumatic headache resolves after 3 months, but persistent post-traumatic headache usually lasts much longer and accounts for 4% of all secondary headache disorders. MAIN BODY The clinical features of post-traumatic headache after traumatic brain injury resemble various types of primary headaches and the most frequent are migraine-like or tension-type-like phenotypes. The neuroimaging studies that have compared persistent post-traumatic headache and migraine found different structural and functional brain changes, although migraine and post-traumatic headache may be clinically similar. Therapy of various clinical phenotypes of post-traumatic headache almost entirely mirrors the therapy of the corresponding primary headache and are currently based on expert opinion rather than scientific evidence. Pharmacologic therapies include both abortive and prophylactic agents with prophylaxis targeting comorbidities, especially impaired sleep and post-traumatic disorder. There are also effective options for non-pharmacologic therapy of post-traumatic headache, including cognitive-behavioral approaches, onabotulinum toxin injections, life-style considerations, etc. CONCLUSION: Notwithstanding some phenotypic similarities, persistent post-traumatic headache after traumatic brain injury, is considered a separate phenomenon from migraine but available data is inconclusive. High-quality studies are further required to investigate the pathophysiological mechanisms of this secondary headache, in order to identify new targets for treatment and to prevent disability.
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Affiliation(s)
- Alejandro Labastida-Ramírez
- Division of Vascular Medicine and Pharmacology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Silvia Benemei
- Health Sciences Department, University of Florence, and Headache Centre, Careggi University Hospital, Florence, Italy
| | - Maria Albanese
- Department of Systems Medicine, Neurology Unit, University of Rome “Tor Vergata”, “Tor Vergata” Hospital, Rome, Italy
| | - Antonina D’Amico
- Department of Child Neuropsychiatry, University of Palermo, Palermo, Italy
| | - Giovanni Grillo
- Department of Child Neuropsychiatry, A.R.N.A.S. Civico, P.O. Giovanni di Cristina Ospedale dei Bambini, Palermo, Italy
| | - Oxana Grosu
- Diomid Gherman Institute of Neurology and Neurosurgery, Headache Centre and Nicolae Testemițanu State University of Medicine and Pharmacy, Chișinău, Republic of Moldova
| | - Devrimsel Harika Ertem
- Department of Neurology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Jasper Mecklenburg
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Pavel Řehulka
- Department of Neurology, St. Anne’s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Francesca Schiano di Cola
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Javier Trigo Lopez
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Nina Vashchenko
- University Clinic of Nervous Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | | | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - On behalf of the European Headache Federation School of Advanced Studies (EHF-SAS)
- Division of Vascular Medicine and Pharmacology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Health Sciences Department, University of Florence, and Headache Centre, Careggi University Hospital, Florence, Italy
- Department of Systems Medicine, Neurology Unit, University of Rome “Tor Vergata”, “Tor Vergata” Hospital, Rome, Italy
- Department of Child Neuropsychiatry, University of Palermo, Palermo, Italy
- Department of Child Neuropsychiatry, A.R.N.A.S. Civico, P.O. Giovanni di Cristina Ospedale dei Bambini, Palermo, Italy
- Diomid Gherman Institute of Neurology and Neurosurgery, Headache Centre and Nicolae Testemițanu State University of Medicine and Pharmacy, Chișinău, Republic of Moldova
- Department of Neurology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Zdorovie Clinic, Tomsk, Russia
- Department of Neurology, St. Anne’s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- University Clinic of Nervous Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
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48
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Lunde CE, Sieberg CB. Walking the Tightrope: A Proposed Model of Chronic Pain and Stress. Front Neurosci 2020; 14:270. [PMID: 32273840 PMCID: PMC7113396 DOI: 10.3389/fnins.2020.00270] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/10/2020] [Indexed: 12/25/2022] Open
Abstract
Pain and stress are both phenomena that challenge an individual’s homeostasis and have significant overlap in conceptual and physiological processes. Allostasis is the ability to adapt to pain and stress and maintain homeostasis; however, if either process becomes chronic, it may result in negative long-term outcomes. The negative effects of stress on health outcomes on physiology and behavior, including pain, have been well documented; however, the specific mechanisms of how stress and what quantity of stress contributes to the maintenance and exacerbation of pain have not been identified, and thus pharmacological interventions are lacking. The objective of this brief review is to: 1. identify the gaps in the literature on the impact of acute and chronic stress on chronic pain, 2. highlight future directions for stress and chronic pain research; and 3. introduce the Pain-Stress Model in the context of the current literature on stress and chronic pain. A better understanding of the connection between stress and chronic pain could provide greater insight into the neurobiology of these processes and contribute to individualized treatment for pain rehabilitation and drug development for these often comorbid conditions.
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Affiliation(s)
- Claire E Lunde
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, United States.,Biobehavioral Pediatric Pain Lab, Boston Children's Hospital, Boston, MA, United States.,Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.,Nuffield Department of Women's and Reproductive Health, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Christine B Sieberg
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, United States.,Biobehavioral Pediatric Pain Lab, Boston Children's Hospital, Boston, MA, United States.,Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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49
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Chan TLH, Woldeamanuel YW. Exploring naturally occurring clinical subgroups of post-traumatic headache. J Headache Pain 2020; 21:12. [PMID: 32033526 PMCID: PMC7006085 DOI: 10.1186/s10194-020-1080-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 01/29/2020] [Indexed: 12/20/2022] Open
Abstract
Objective To explore naturally occurring clinical subgroups of post-traumatic headache. Background Persistent post-traumatic headache (PTH) is defined as a headache developing within 7 days of an injury that lasts for greater than 3 months. However, there is no evidence available from the International Classification of Headache Disorders (ICHD) based classification between persistent and acute PTH based on clinical phenotypes. Methods We conducted a retrospective study using the Stanford Research Repository Cohort Discovery Tool. We reviewed 500 electronic patient charts between January 2015 to September 2019 using inclusion criteria of adults older than 18 years with a diagnosis of PTH. The following variables were extracted from each patient’s chart: diagnosis of PTH as dependent variable, and predictor variables as age, sex, history of migraine, loss of consciousness during head injury, pre-existing psychological history, duration of PTH and new PTH-associated comorbidities (e.g. new onset vertigo, post-traumatic stress disorder). Logistic regression was employed to identify clinical phenotypes predicting persistent PTH. All predictor variables were tested in one block to determine their predictive capacity while controlling for other predictors in the model. Two-step cluster analysis was conducted to identify naturally occurring PTH subgroups. Results A total of 300 patients were included (150 acute, 150 persistent PTH) with a median age of 47 years (IQR 31, 59) and female: male ratio of 2.7:1. Two hundred patients were excluded due to misdiagnoses. Pre-existing psychological history (standardized beta 0.16), history of migraine (0.20), new PTH-associated comorbidities (0.23) and medication overuse (0.37) statistically significantly predicted the presence of persistent PTH (p < 0.0001). Clustering analysis revealed PTH subgrouping comparable to ICHD-based classification: 140 patients in Cluster 1 (76% persistent PTH) and 160 patients in Cluster 2 (83% acute PTH). Four distinct clusters were found within persistent PTH. Conclusion Pre-existing psychological history, history of migraine, new PTH-associated comorbidities and medication overuse predicted the occurrence of persistent PTH as well as two naturally occurring PTH clusters correlating to acute and persistent PTH. Management emphasis should focus on these phenotypes.
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Affiliation(s)
- T L H Chan
- Division of Headache & Facial Pain, Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, California, USA.
| | - Y W Woldeamanuel
- Division of Headache & Facial Pain, Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, California, USA
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50
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Arbour C, Bouferguene Y, Beauregard R, Lavigne G, Herrero Babiloni A. Update on the prevalence of persistent post-traumatic headache in adult civilian traumatic brain injury: protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e032706. [PMID: 31974086 PMCID: PMC7045127 DOI: 10.1136/bmjopen-2019-032706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 12/17/2019] [Accepted: 12/20/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) is a major public health concern. Persistent post-traumatic headache (PTH) is a common consequence of TBI affecting productivity and quality of life. The only review providing information about headache prevalence after TBI was published in 2008, combined data from civilian and military TBI, and was strictly derived from Medline database. Due to recent changes in TBI diagnosis and trauma epidemiology, the aim of the current study is to perform a systematic review and meta-analysis to derive updated prevalence estimates of persistent PTH in adult civilian TBI. METHODS AND ANALYSIS The methods have been defined following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies published from 2008 to 2019 will be identified searching the electronic databases Medline, Embase, Cochrane, Google Scholar, Directory of Open Access Journals and Web of Science. Retrieved records will be independently screened by two authors and relevant data will be extracted from studies reporting data on persistent PTH prevalence among civilian TBI individuals (≥16 years). The pooled prevalence estimates of any form of headache will be computed applying random-effects meta-analysis. Heterogeneity will be assessed using the I2 statistic and explored through subgroup analyses considering TBI severity (mild vs moderate/severe). Estimations of risk of bias will be performed using the Risk of Bias Tool for Prevalence Studies. ETHICS AND DISSEMINATION The result of this systematic review will be published in a peer-reviewed journal and disseminated at relevant conferences presentations. Formal ethical approval is not required because we will search and evaluate only existing sources of literature. By focusing on studies conducted in the last decade, this review will provide the most up-to-date information about the global prevalence of persistent PTH after TBI. Considering the economical and social burden of persistent PTH after TBI, accurate estimates of this problematic disorder is of utmost importance for planning, implementing and evaluating prevention interventions. PROSPERO REGISTRATION NUMBER CRD42018094138.
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Affiliation(s)
- Caroline Arbour
- Surgical care and trauma department, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Yasmine Bouferguene
- Surgical care and trauma department, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Roxanne Beauregard
- Surgical care and trauma department, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Gilles Lavigne
- Surgical care and trauma department, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Alberto Herrero Babiloni
- Surgical care and trauma department, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
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