# Mechanisms and Therapeutic Strategies for Post-traumatic Headache

> **NIH NIH R01** · UNIVERSITY OF ARIZONA · 2020 · $487,295

## Abstract

Post-traumatic headache (PTH) commonly occurs following mild traumatic brain injury (mTBI), also known as
concussion. PTH is a secondary headache that often presents with a migraine-like phenotype and is subdivided
as acute or persistent (PPTH) depending on whether it resolves within 3 months after injury. The pathophysiology
of PTH and PPTH is not understood and no evidence-based treatments exist for these conditions. Critically,
PPTH might differ from PTH, not only in the duration but also in underlying mechanisms and responsiveness to
treatment. The reasons for emergence of PPTH in some patients remain unclear but may be related to risk
factors including pre-existing migraine and the experience of a previous mTBI. We have developed an approach
to investigate the mechanisms of PTH and PPTH as well as potential strategies for treatment. Using a weight
drop method in male and female mice that recapitulates biomechanical properties and clinical features of mTBI,
we have shown that a single mTBI is sufficient to induce clinically relevant PTH symptoms including an acute
period of allodynia, elevated CGRP blood levels and lowered thresholds for induction of cortical spreading
depression (CSD). Additionally, we have explored the concept that the transition from acute to chronic pain
states may rely on a “pain memory” that can be studied using the “two-hit” model of hyperalgesic priming where
a prior insult confers vulnerability to a subsequent provocative stimulus. Thus, following resolution of acute
allodynia, mTBI mice transition into a long-lasting persistent phase (PPTH) where, remarkably, allodynia can be
reinstated by physiologically relevant and common migraine triggers, including stress. CGRP is established in
migraine pathogenesis and our data also suggest an important role in promoting PTH. Treatment with either a
CGRP antibody or with onabotulinum toxin A (botox) prevents mTBI-related allodynia (PTH) as well as
subsequent provoked allodynia representative of PPTH. However, blockade of CGRP after mTBI sensitization
is established is ineffective in blocking provoked allodynia, while botox still maintains efficacy. We have
hypothesized that mTBI results in CGRP release from meningeal afferents promoting PTH and central
sensitization that underlies the development of PPTH, but that PPTH may be maintained in a CGRP-independent
fashion. Additionally, we hypothesize that existing sensitization prior to a mTBI event will promote vulnerability
to the development of CGRP-independent PPTH. We explore these hypotheses with two related but,
independent, aims using behavioral, neurochemical, immunohistochemical and electrophysiolgical analyses.
Aim 1 will determine whether, and when currently available therapies can block mTBI-related outcomes relevant
to PTH and if these treatments can prevent the expression of PPTH. Aim 2 will determine if prior sensitization
promotes more severe, long-lasting and CGRP-resistant PPTH. Our studies will fill in signific...

## Key facts

- **NIH application ID:** 10049029
- **Project number:** 1R01NS114888-01A1
- **Recipient organization:** UNIVERSITY OF ARIZONA
- **Principal Investigator:** Trent Anderson
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $487,295
- **Award type:** 1
- **Project period:** 2020-07-15 → 2025-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10049029

## Citation

> US National Institutes of Health, RePORTER application 10049029, Mechanisms and Therapeutic Strategies for Post-traumatic Headache (1R01NS114888-01A1). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10049029. Licensed CC0.

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