Many Migraine Patients Have Mild TBI History

— More migraine disability, anxiety, and depression in these people, registry data show


More than one in three migraine patients had a history of mild traumatic brain injury (TBI), registry data showed.

Of 1,098 migraine patients in the American Registry for Migraine Research () database, 37.6% reported having a mild TBI in the past, reported Ryotaro Ishii, MD, PhD, of Mayo Clinic in Phoenix, Arizona, in a presentation at the American Headache Society virtual meeting.

These patients had more migraine-related disability, were more likely to experience dizziness and vertigo, and had a higher level of anxiety and depression than people without mild TBI history.

History of TBI should be assessed in patients presenting with migraine, and people with migraine who have a high exposure risk to mild TBI or repetitive head impacts should be aware of the potential for migraine progression, Ishii said.

"In clinical practice, medical doctors need to get information from patients with migraine in a very limited time," he told app. "Brainstem symptoms and reading as triggers might be good hints to ask about the history of mild TBI."

The study looked at 1,098 migraine patients without a prior diagnosis of post-traumatic headache who participated in ARMR between February 2016 and March 2020, and who answered questions about mild TBI history. Migraine diagnoses were made by headache specialists using International Classification of Headache Disorders () criteria.

Ishii and colleagues evaluated demographics, headache characteristics, triggers of headache, Patient Health Questionnaire-2 () grades, General Anxiety Disorder-7 ( grades, and Migraine Disability Assessment Scale () scores in these patients. PHQ-2 assesses the frequency of depressed mood, GAD-7 is a screening tool for generalized anxiety, and MIDAS measures the effect of headache attacks on daily activities over 3 months.

A total of 413 people had mild TBI in the past. There were no significant demographic differences between people with or without mild TBI history, and no significant difference in the proportion of patients having nausea during headache attacks.

Migraine patients with a history of mild TBI were more likely to have dizziness (P=0.006), vertigo (P=0.010), and difficulty finding words (P<0.001). Their headaches were more likely to be triggered by lack of sleep (39.4% vs 32.6%, P=0.032), bright lights (21.4% vs 16.3%, P=0.045), and reading (6.6% vs 3.0%, P=0.007).

People in the mild TBI group had significantly greater scores on the MIDAS (42 vs 34.5, P=0.010) and PHQ-2 score (24.2% vs 20.1%, P=0.012). They also had a significantly higher proportion of moderate to severe GAD-7 grade (21.7% vs 17.3%, P=0.016).

Features of post-traumatic headache and migraine are similar and little is known about the effect of mild TBI on migraine patients, Ishii noted. "Many studies of post-traumatic headache exclude patients with migraine and many studies of migraine exclude patients with post-traumatic headache," he pointed out.

Previous research from Canada has shown that people with a pre-injury accident lifetime history of migraine had significantly more concussion symptoms and higher symptom severity scores after mild TBI than people without migraine history.

  • Judy George covers neurology and neuroscience news for app, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more.


Ishii disclosed no relationships with industry.

Primary Source

American Headache Society

Ishii R, et al "A history of mild traumatic brain injury is associated with disability and severity of migraine" AHS 2021.