R ES E A R C H A R T I C L E Open Access
Persistent post-traumatic headache vs.
migraine: an MRI study demonstrating
differences in brain structure
Todd J. Schwedt
, Catherine D. Chong
, Jacob Peplinski
, Katherine Ross
and Visar Berisha
Background: The majority of individuals with post-traumatic headache have symptoms that are indistinguishable
from migraine. The overlap in symptoms amongst these individuals raises the question as to whether post-traumatic
headache has a unique pathophysiology or if head trauma triggers migraine. The objective of this study was to
compare brain structure in individuals with persistent post-traumatic headache (i.e. headache lasting at least 3 months
following a traumatic brain injury) attributed to mild traumatic brain injury to that of individuals with migraine.
Methods: Twenty-eight individuals with persistent post-traumatic headache attributed to mild traumatic brain injury
and 28 individuals with migraine underwent brain magnetic resonance imaging on a 3 T scanner. Regional volumes,
cortical thickness, surface area and curvature measurements were calculated from T1-weighted sequences and compared
between subject groups using ANCOVA. MRI data from 28 healthy control subjects were used to interpret the differences
in brain structure between migraine and persistent post-traumatic headache.
Results: Differences in regional volumes, cortical thickness, surface area and brain curvature were identified when
comparing the group of individuals with persistent post-traumatic headache to the group with migraine. Structure was
different between groups for regions within the right lateral orbitofrontal lobe, left caudal middle frontal lobe, left superior
frontal lobe, left precuneus and right supramarginal gyrus (p < .05). Considering these regions only, there were differences
between individuals with persistent post-traumatic headache and healthy controls within the right lateral orbitofrontal
lobe, right supramarginal gyrus, and left superior frontal lobe and no differences when comparing the migraine cohort to
Conclusions: In conclusion, persistent post-traumatic headache and migraine are associated with differences in brain
structure, perhaps suggesting differences in their underlying pathophysiology. Additional studies are needed to further
delineate similarities and differences in brain structure and function that are associated with post-traumatic headache
and migraine and to determine their specificity for each of the headache types.
Keywords: Post-traumatic headache, Migraine, Traumatic brain injury, Magnetic resonance imaging, Brain structure,
Brain volume, Brain curvature, Brain surface area, Cortical thickness
* Correspondence: Schwedt.firstname.lastname@example.org
Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85255, USA
Full list of author information is available at the end of the article
The Journal of Headache
© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made.
Schwedt et al. The Journal of Headache and Pain (2017) 18:87