No evidence of intracranial hypotension in persistent post-traumatic headache: A magnetic resonance imaging study

BackgroundPersistent post-traumatic headache (PTH) is frequent, and intracranial hypotension may be an important cause of PTH. The present study aimed to examine whether magnetic resonance imaging (MRI) signs of intracranial hypotension are more frequent in people with persistent PTH than in healthy controls (HCs).MethodsAdults with persistent PTH attributed to mild traumatic brain injury and age- and sex-matched HCs attended a single non-contrast, brain MRI 3T session. Fluid attenuated inversion recovery T1- and T2-weighted sequences were acquired to assign a modified Bern score. The score ranges from 0 to 9 points, with higher scores indicating a greater probability of cerebrospinal fluid (CSF) leakage leading to intracranial hypotension. The primary outcome was the difference in modified Bern score between participants with persistent PTH and HCs. All images were examined by a certified neuroradiologist who was blinded to the group status.ResultsImaging data from 97 participants with persistent PTH and 96 age- and sex-matched HCs were eligible for analyses. A modified Bern score of ≤2 was present in 90 (93%) participants with persistent PTH and 85 (89%) HCs, indicating a low probability of CSF leak. None of the persistent PTH participants or the HCs had a score of >4. There were no significant differences in modified Bern scores between participants with persistent PTH and HCs.ConclusionsThere is a low prevalence of typical MRI Bern score signs of intracranial hypotension in PTH or HCs. Thus, intracranial hypotension is unlikely to be an underlying factor in persistent PTH attributed to mild traumatic brain injury.Trial RegistrationThe study was registered on ClinicalTrials.gov (identifier: NCT03791515). Date of registration 2018-12-29.