Altered Brain Network Connectivity underlies Persistent Post-Traumatic Headache following mTBI in Youth.

BACKGROUND Post Traumatic Headaches (PTH) are associated with mild traumatic brain injuries (mTBI) and may predict the persistence of other concussion related symptoms. Altered brain networks implicated in brain injury and the affective components of headache-related pain may underlie the resolution or persistence of PTH. OBJECTIVE To evaluate the extent to which pain symptom reporting and functional brain changes are different in a cohort of young mTBI patients with resolved (PTH-R) and persistent (PTH-P) post-traumatic headache symptoms relative to healthy controls. METHODS This was a cross-sectional investigation. Data from 59 participants (PTH-P=21; PTH-R=18; 20 healthy control) were between the ages of 12-24. Participants had no significant history of preexisting headaches, chronic pain, or psychiatric neurological conditions. The primary outcome was resting-state functional connectivity (RS-Fc) alterations between cohorts. Secondary outcomes were self-reported pain-related symptoms such as fear of pain and pain catastrophizing. RESULTS Elevated scores were reported for fear of pain in both PTH cohorts. Relative to healthy controls, PTH-P cohort showed altered connectivity in brain regions such as the Frontal, Temporal and Cerebellar regions, as well as sub-cortical regions including the Amygdala and Accumbens. The PTH-R cohort showed altered RS-Fc between Cerebellar and Temporal lobe sub-regions. CONCLUSIONS Our results indicate a core network of brain regions implicated in the affective pain response are functionally altered in PTH cohorts. Despite the resolution of symptoms, persons who experience PTH following a mTBI may experience ongoing functional brain abnormalities. Observed group differences may underlie symptom chronification.