Biological Markers of Brain Network Connectivity and Pain Sensitivity Distinguish Low Coping from High Coping Veterans with Persistent Post-Traumatic Headache.

Headache is the most common pain complaint following mild traumatic brain injury. Roughly half of those with persistent post-traumatic headache (PPTH) also report neck pain, which is associated with greater severity and functional impact of headache. This observational cohort study aimed to identify biological phenotypes to help inform mechanism-based approaches in the management of PPTH with co-occurring neck pain. Thirty-three military veterans [mean (standard deviation) = 37 ± 16 years, 29 males] with PPTH completed a clinical assessment, quantitative sensory testing, and magnetic resonance imaging of the brain and cervical spine. Multidimensional phenotyping was performed using a Random Forest analysis and Partitioning Around Medoids clustering of input features from three biological domains: (1) resting state functional connectivity (rsFC) of the periaqueductal gray (PAG), (2) quality and size of cervical muscles, and (3) mechanical pain sensitivity and modulation. Two subgroups were distinguished by biological features that included forehead pressure pain threshold and rsFC between the PAG and selected nodes within the default mode, salience, and sensorimotor networks. Compared to the High Pain Coping group, the Low Pain Coping group exhibited higher pain-related anxiety (p = 0.009), higher pain catastrophizing (p = 0.004), lower pain self-efficacy (p = 0.010), and greater headache-related disability (p = 0.012). Although limited by a modest sample size, findings suggest that greater functional connectivity of pain modulation networks involving the PAG combined with impairments in craniofacial pain sensitivity, but not cervical muscle health, distinguish a clinically important subgroup of individuals with PPTH who are less able to cope with pain and more severely impacted by headache.