Objective:

To evaluate the efficacy of a methylprednisolone taper in improving the frequency and severity of post-traumatic headache (PTH).

Background:

PTH is prevalent after mild traumatic brain injuries (mTBI) and data on  pharmacologic management is limited. Corticosteroids, particularly methylprednisolone tapers, are a potential treatment option given their anti-inflammatory properties, though the use of such agents in this context remains poorly studied.

Design/Methods:

This retrospective cohort study sought to determine PTH response after administration of a methylprednisolone taper. Subjects rated PTH on a Likert scale from 0 (none) to 6 (severe) pre- and post-intervention, in variable frequency after injury. PTH phenotype, history of headache before injury, and other pharmacologic treatments prescribed were factored into the analysis. A paired t-test was used to test the mean differences between pre- and post-treatment headache scores. Independent t-test and one-way ANOVA as appropriate were used to compare mean differences across demographic and clinical variables.

Results:

50 subjects were included in the final analysis. A paired-samples t-test showed a reduction from the pre-treatment headache score (Mean = 3.91, SD = 1.38) to post-treatment (Mean = 2.58, SD = 1.90; t= 5.3, p < 0.01, d=-1.33). Patients without depression showed significant improvement (Mean (SD): 3.72(1.27) vs 2.14 (1.73)), while patients with depression did not (Mean (SD) : 4.67(1.58) vs 4.33 (1.58)). Significant improvement in post treatment headache scores was observed in patients with mood disturbance (Mean (SD): 4.19(1.45) vs 3.00 (1.92, p=0.001) and with sleep disturbance (Mean (SD):4.16 (1.32) vs 3.28(1.69), p=0.005). Similar improvements were also observed in patients without mood (Mean (SD):3.08 (0.79) vs 1.50(1.50), p=0.002) and sleep disturbance (Mean(SD): 3.30 (1.38 vs 0.84 (1.14)).

Conclusions:

This study demonstrates that methylprednisolone tapers significantly decrease the severity of PTH. This effect is even more pronounced in patients with depression, mood and sleep disturbance.