The link between migraine genetics and post-concussion headaches in kids

A University of Calgary-led study has found evidence that children with genes predisposing them to migraine might have an increased risk of having more headaches after a concussion, which are known to be linked to prolonged symptoms up to six months after the injury. Dr. Serena Orr, MD, an associate professor in the Cumming School of Medicine, and Dr. Keith Yeates, PhD, a professor in the Faculty of Arts, led the study which looked at over 600 children aged 8 to 16 who presented with symptoms of concussion, and followed them for six months post injury. The work is published in the journal Neurology Genetics.

It is the first study that has looked at specific genetic factors for migraine and post-concussion outcomes. The team looked at migraine genetics in three ways: reporting of family history, a polygenic risk score (i.e., a score that quantifies the genetic risk of migraine by adding up the effects of migraine-associated genetic mutations within an individual), and specific genetic mutations. They found that a family history of migraine and mutations in four genes were associated with a higher risk of getting headaches of increasing severity after a concussion in children.

“There is increasing interest in the genetics of headache, and the reason for that is helping identify who is at risk. If you know the biological systems that the genes govern, you can begin to identify who is going to respond to which medications, and even begin to develop new medications,” says Dr. Keith Yeates, principal investigator on the study.

Knowing that a child or adolescent who has more genes for migraine could have worse post-concussion outcomes is important information for treatment providers, as the patient with a genetic predisposition may require more monitoring or earlier and more targeted treatment for headache. There are also potential implications for which treatment to give, including which pain medication could have the most benefit. The researchers say that in the future, rapid genetic testing could show who is susceptible to post-concussion headaches, opening the door for personalized treatments.

“There’s a signal here that having migraine genes might increase your risk of having more headaches after concussion, which we know is associated with worse long-term outcomes after concussion,” says Dr. Serena Orr, first author of the study.

Migraine is the leading cause of disability associated with neurological disorders in children and adolescents and into early and mid adulthood. Beyond headache, a number of post-concussion symptoms, including blurred vision, balance issues, and dizziness, may be related to migraine as well. The researchers say post-concussion headache can have a significant impact on a child or adolescent’s daily life, including performance in school and participation in social relationships.

The next step for researchers will be to replicate the study and results in other populations, including adults. The researchers say the study is an exciting first step, as it demonstrates that family history of migraine matters and that specific gene mutations that relate to post-concussion outcomes.