Reader response: Posttraumatic vs nontraumatic headaches: A phenotypic analysis in a military population
Vinod K.Gupta, Physician-Medical Director, Migraine-Headache Institution (New Delhi, India)
Submitted January 11, 2020
I read the article by Metti et al.1 Diagnosis through questionnaires must always be supplemented with specialist consultations. In a larger cohort, stress-resilience or stress-resistance and stress-susceptibility could have emerged. Ideally, such studies should be carried out pre-deployment. The authors recommend further phenotypic fractionation of post-traumatic headaches into subgroups. Primary headache has already reached a zenith of purely narrative “splitting.” It is hard to understand how more subgroups might be clinically and therapeutically valid. Conversely, such progressive “splitting” makes it increasingly difficult for a unifying synthesis to emerge. Also, visual aura reported1 must specify whether scintillating scotoma has been recorded.
Focus on the post-traumatic subgroup (n=327) without headache1 is critically important. PTH- or migraine-like headache-free patients set forward the principle that there would be physiologic mechanisms that are adaptive and protect against the development or appearance of headache.2,3,4 As the commonest neurologic disorder, the data bank of migraine is vast and intimidating but is making no vertical progress. Division of observed phenomenon—clinical, laboratory, neuroimaging, and therapeutic data—into adaptive and non-nonadaptive compartments would help challenge existing myths and assumptions.3,4,5 The physiologic basis for such an organization of data has been presented.2,3,4,5
Disclosure
The author reports no relevant disclosures. Contact journal@neurology.org for full disclosures.
References
Metti A, Schwab K, Finkel A et al. Posttraumatic vs nontraumatic headaches: A phenotypic analysis in a military population. Neurology 2020 Epub Jan 10.
Gupta VK, editor. Adaptive Mechanisms in Migraine: A Comprehensive Synthesis in Evolution: Breaking the Migraine Code. New York: Nova Science Publishers, 2009.
Gupta VK. CSD, BBB and MMP-9 elevations: animal experiments versus clinical phenomena in migraine. Expert Rev Neurother. 2009;9:1595–1614.
Gupta VK. Pathophysiology of migraine: an increasingly complex narrative to 2020. Future Neurol 2019 Epub May 24.
I read the article by Metti et al.1 Diagnosis through questionnaires must always be supplemented with specialist consultations. In a larger cohort, stress-resilience or stress-resistance and stress-susceptibility could have emerged. Ideally, such studies should be carried out pre-deployment. The authors recommend further phenotypic fractionation of post-traumatic headaches into subgroups. Primary headache has already reached a zenith of purely narrative “splitting.” It is hard to understand how more subgroups might be clinically and therapeutically valid. Conversely, such progressive “splitting” makes it increasingly difficult for a unifying synthesis to emerge. Also, visual aura reported1 must specify whether scintillating scotoma has been recorded.
Focus on the post-traumatic subgroup (n=327) without headache1 is critically important. PTH- or migraine-like headache-free patients set forward the principle that there would be physiologic mechanisms that are adaptive and protect against the development or appearance of headache.2,3,4 As the commonest neurologic disorder, the data bank of migraine is vast and intimidating but is making no vertical progress. Division of observed phenomenon—clinical, laboratory, neuroimaging, and therapeutic data—into adaptive and non-nonadaptive compartments would help challenge existing myths and assumptions.3,4,5 The physiologic basis for such an organization of data has been presented.2,3,4,5
Disclosure
The author reports no relevant disclosures. Contact journal@neurology.org for full disclosures.
References