Treatment of Persistent Post-Traumatic Headache with the Anti-CGRP Receptor Antibody Erenumab: A Case Report

Introduction: Calcitonin gene-related peptide (CGRP) has only recently emerged as a potential target in posttraumatic headache. To our knowledge this is the first description of a patient with persistent posttraumatic headache following severe traumatic head injury who has been treated with the CGRP-receptor-monoclonal antibody erenumab.Case presentation: A 56-year-old man presented with a 30-year history of frequent migraine-like posttraumatic headaches following a high-voltage head injury that he treated with an excessive intake of peripheral analgesics. Although amitriptyline was reasonably effective, it had to be discontinued when the patient developed restless legs syndrome in the second year of treatment. Under therapy with erenumab he achieved a rapid and stable reduction in his symptoms down to only 2–3 headache days per month without adverse events.Conclusions: This case demonstrates that the inhibition of the CGRP-receptor with erenumab could be an effective treatment option in migraine-like post-traumatic headache even decades after the traumatic event.

Somatosensory dysfunction in patients with posttraumatic headache: A systematic review

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.

Treatment of Persistent Post-traumatic Headache With the anti-CGRP Receptor Antibody Erenumab: a Case Report

Background: Calcitonin gene-related peptide (CGRP) has only recently emerged as a potential target in posttraumatic headache. To our knowledge this is the first description of a patient with persistent posttraumatic headache following severe traumatic head injury who has been treated with the CGRP-receptor-monoclonal antibody erenumab.Case presentation: A 56-year-old man presented with a 30-year history of frequent migraine-like posttraumatic headaches following a high-voltage head injury that he treated with an excessive intake of peripheral analgesics. Although amitriptyline was reasonably effective, it had to be discontinued when the patient developed restless legs syndrome in the second year of treatment. Under therapy with erenumab he achieved a rapid and stable reduction in his symptoms down to only 2–3 headache days per month without adverse events.Conclusions: This case demonstrates that the inhibition of the CGRP-receptor with erenumab could be an effective treatment option in migraine-like post-traumatic headache even decades after the traumatic event.

Prescription Medication for Posttraumatic Headache Following Concussion: A Critically Appraised Topic

Clinical Question: In individuals with posttraumatic headache following concussion, what impact does medication have? Clinical Bottom Line: Prescription medications may be beneficial for those suffering posttraumatic headache following concussion by decreasing headache symptoms and improving cognitive function, though long-term outcomes were similar between those taking and not taking medications.

Reason to doubt the ICHD-3 7-day inclusion criterion for mild TBI-related posttraumatic headache: A nested cohort study

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