The effect of multidisciplinary open-label treatment in patients with persistent post-traumatic headache at two tertiary headache centers

Background: Persistent post-traumatic headache (PTH) is a frequent and disabling sequela of mild traumatic brain injury. This proof-of-concept study investigated whether a one-year multidisciplinary intervention could reduce PTH and other post-concussion symptoms in patients treated at the Danish Headache Center and the Headache Center in Southwest Jutland. Methods: This prospective, non-randomized cohort study included consultations with a doctor, nurse, physiotherapist, and psychologist, and offered pharmacological treatment with candesartan, amitriptyline, or gabapentin. Data were collected before and after the intervention using medical records and electronic questionnaires, including the Rivermead Post-Concussion Symptoms Questionnaire, Hospital Anxiety and Depression Scale (HADS), and Insomnia Severity Index (ISI). Results: Fifty-eight patients with PTH (mean duration 36 months) were enrolled between August 2021 and February 2023. Headache frequency decreased by 1.7 days per month (p = 0.044). There were no significant changes in acute medication use (p = 0.965), Rivermead score (p = 0.169), HADS-anxiety (p = 0.792), HADS-depression (p = 0.898), ISI (p = 0.138), physical activity (p = 0.071), or self-rated health (p = 0.598). Candesartan, amitriptyline, and gabapentin were reported effective by 28%, 6.5%, and 22% of users, respectively. Conclusion: A comprehensive multidisciplinary program did not produce clinically meaningful improvement in headache or associated symptoms, although patient satisfaction remained high. Further research is needed to improve treatment strategies. Clinical trial registration: The ClinicalTrials.gov identifier is NCT05328635.