PTH is the most common sequala after a traumatic brain injury (TBI), affecting up to 75% of patient with mild TBI. No FDA approved medication exists for PTH, and many patients are concerned about side effects or have contraindications to tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and antiepileptic medications. Since glutamate level rise after concussions and during migraines, targeting glutaminergic activity may offer a new therapeutic approach. Memantine, a glutamatergic N-methyl-D-aspartate (NMDA) receptor antagonist, has shown efficacy in migraine treatment, suggesting potential benefit for PTH.

A retrospective chart review of 1,577 pediatric and adult patients who experienced a mTBI and had PTH over the course of 15 months was performed. All patients were seen in a tertiary concussion clinic. Of the 1,577 patients reviewed, 25 individuals (13 males, 12 females, ages 14 to 62 years-old) who were prescribed memantine were included in analyses. Headache phenotypes included migraine without aura (22 patients), migraine with aura (2 patients), and trigeminal autonomic cephalalgia (1 patient). Ten patients had tried one prior preventative and six patients had tried two or more preventative treatments. At follow-up visits, patients reported whether memantine was helpful and headache frequency.

This study demonstrates quantitively and qualitatively that memantine may be a unique preventative treatment for PTH in pediatric and adult patients. Memantine could be an additional medication option for a challenging secondary headache disorder and post-concussion symptoms.