{
  "abstract": "Traumatic brain injury global prevalence is estimated to be over 55 million, with a direct economic primary care cost in Australia for mild traumatic brain injury(mTBI) of around $50 million annually, and headache and migraine after mild traumatic brain injury (mTBI) are commonly seen in around 40% of cases. Divided into subcategories of Acute Post-Traumatic Headache and Persistent Post-Traumatic Headache (APTH/PPTH) under the International Classification of Headache Disorders (ICHD-3), significant gaps remain in our understanding of APTH/PPTH pathophysiology and its management. The molecular mechanisms of mTBI (from both direct and indirect injury) as well as clinical outcomes are wide-ranging, and as yet there are no clinical biomarkers to differentiate cerebral related structural inflammation or injury from APTH/PPTH related neurological dysfunction. Further, there are no direct neural treatments available for post mTBI, and current approaches remain largely supportive under a coordinated multidisciplinary framework, including vestibular therapy, symptom-limited physical therapy, and cognitive behavioural therapy. By contrast, pharmaceutical options are readily available for episodic and chronic migraine include amitriptyline, pizotifen, topiramate, propranolol and candesartan, therapies targeting CGRP (monoclonal antibodies and receptor antagonists) onabotulinum toxin A, or greater occipital perineural steroid injection, and these may be underutilised after mTBI. The Guidelines of the International Headache Society for controlled trials of pharmacological preventive treatment for persistent post-traumatic headaches attributed to mild traumatic brain injury were recently developed, and performing clinical trials of commonly used migraine agents to understand APTH/PPTH response will better inform rehabilitation approaches after mTBI.",
  "authors": [
    {
      "affiliations": [
        "Queensland Brain Institute, North Sydney, NSW, Australia",
        "Mater Hospital Sydney, Sydney, NSW, Australia"
      ],
      "name": "Rowena Mobbs"
    },
    {
      "affiliations": [
        "Department of Neurology, St Vincent’s Hospital, Sydney, NSW, Australia"
      ],
      "name": "Susan Tomlinson"
    },
    {
      "affiliations": [
        "Queensland Brain Institute, North Sydney, NSW, Australia"
      ],
      "name": "Fatima Nasrallah"
    },
    {
      "affiliations": [
        "Neurology, King’s College – NIHR-Wellcome Trust King’s Clinical Research Facility, London, UK",
        "University of California, Los Angeles, U.S.A"
      ],
      "name": "Peter Goadsby"
    },
    {
      "affiliations": [
        "Emergency and Urgent Care Research in Cambridge (EURECA), PACE Section, Department of Medicine, Cambridge University, Cambridge, UK"
      ],
      "name": "Virginia Newcombe"
    },
    {
      "affiliations": [
        "Department of Neurology, Royal North Shore Hospital, Sydney, NSW, Australia"
      ],
      "name": "Bronwyn Jenkins"
    },
    {
      "affiliations": [
        "Faculty of Health and Medicine, Save Sight Institute, University of Sydney, Sydney, NSW, Australia",
        "Macquarie Ophthalmology, School of Clinical Medicine, Macquarie University, NSW, Australia"
      ],
      "name": "Clare Fraser"
    },
    {
      "affiliations": [
        "Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, TAS, Australia"
      ],
      "name": "Jenna Ziebell"
    },
    {
      "affiliations": [
        "Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia",
        "Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia"
      ],
      "name": "Robert Adam"
    },
    {
      "affiliations": [
        "Department of Neurology, Macquarie University Hospital, Macquarie University, NSW, Australia"
      ],
      "name": "Alessandro Fois"
    },
    {
      "affiliations": [
        "Department of Psychology, Macquarie University, NSW, Australia"
      ],
      "name": "Anthony Mobbs"
    }
  ],
  "title": "3585 Migraine after mild traumatic brain injury: current treatment approaches and research challenges",
  "uid": "c7a7ca80-03b2-594e-8e23-893aaadf1615"
}