Joseph Delic MD, Presenter: Nothing to Disclose

Lea M. Alhilali MD, Abstract Co-Author: Nothing to Disclose

Michael W. Collins PhD, Abstract Co-Author: Nothing to Disclose

Saeed Fakhran MD, Abstract Co-Author: Nothing to Disclose

To determine if a central axonal injury underlies migraine headaches and their variants after mild traumatic brain injury (mTBI) utilizing tract-based spatial statistics (TBSS) analysis of diffusion tensor imaging (DTI).

DTI was performed in 58 mTBI patients with post-traumatic migraine headaches, including 35 patients with post-traumatic headaches (PTH) with photophobia, 33 with PTH with nausea, 33 with PTH with phonophobia, and 5 patients with post-traumatic migraines with aura. Controls consisted of 17 mTBI patients without migraine headaches. Fractional anisotropy (FA) maps were generated as a measure of white matter integrity and analyzed using TBSS regression analysis utilizing a general linear model and unpaired t-tests.

Compared to controls, mTBI patients with post-traumatic migraines had significantly decreased FA values in the body of the corpus callosum (p<0.05), a region previously found to have decreased FA in non-traumatic migraine patients, and fornix (p<0.05). Patients with PTH with photophobia, phonophobia, and nausea, likewise all had significantly decreased FA in the corpus callosum compared to controls (p<0.05), with patients with PTH with photophobia also having decreased FA in the fornix and patients with PTH with phonophobia or nausea also having decreased FA in the brainstem relative to controls (p<0.05). No regions of significantly decreased FA were found in mTBI patients with migraines with aura compared to controls.

White matter injuries underlying post-traumatic migraines are similar to known white matter abnormalities in non-traumatic migraine patients, suggesting a common pathophysiology. Injuries to the corpus callosum were common among patients with PTH, regardless of the type of migrainous symptom, although additional regions of white matter injury were seen in the brainstem in mTBI patients presenting with PTH with phonophobia or nausea.

The similarity of white matter injuries underlying post-traumatic migraines to non-traumatic migraine abnormalities suggests a similar pathophysiology, which may aide our understanding of the origins of these headaches as well as assist in their treatment. The presence of white matter injuries in the brainstem in post-traumatic migraine patients with nausea or phonophobia, however, indicates additional complexity in this subset of patients.

Delic, J, Alhilali, L, Collins, M, Fakhran, S, Evaluation of White Matter Injuries Underlying Migraine Headaches after Mild Traumatic Brain Injury.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045674.html