Differences in cortical morphometry between persistent post-traumatic headache, migraine and healthy controls

Background Persistent post-traumatic headache (PTH) is a prevalent and disabling neurological disorder, often attributed to mild traumatic brain injury and resembling migraine in clinical features. The underlying cortical morphometric changes and their relevance to persistent PTH remain unclear. Methods This cross-sectional magnetic resonance imaging (MRI) investigation enrolled 103 adults with persistent PTH, 296 with migraine and 155 healthy controls (HC), to undergo structural MRI at 3T. Cortical surface area, thickness and volume were evaluated in FreeSurfer. The analyses applied cluster-determining thresholds of p < 0.001 and cluster-wise thresholds of p < 0.05, adjusted for age, sex and total intracranial volume. Results Participants with persistent PTH exhibited larger surface area in the right anterior and posterior cingulate cortex ( p cluster = 0.003), as well as the right superior parietal cortex/postcentral gyrus, compared to HC ( p cluster < 0.035). No morphometric differences were observed between participants with persistent PTH and migraine (including subgroups: episodic, chronic, with aura without aura). Conclusions These findings reveal morphometric alterations in persistent PTH, specifically within pain processing regions of the mid-cingulate and somatosensory cortex. Similar changes have been reported in migraine, suggesting a shared neurobiological substrate. These enlargements might reflect adaptations to recurrent nociceptive stimuli that sustain persistent PTH.