Our prior work demonstrated that questionnaires assessing psychosocial symptoms have utility of predicting PTH persistence. Here, we aimed to determine whether classification accuracy was improved when adding structural brain measures to the model.

43 patients with aPTH (mean age=43.0, SD=12.4) and 61 HC were enrolled (mean age= 39.1, SD=12.8). At three-month follow-up, 26 aPTH patients had headache improvement and 17 did not. The final model trained on questionnaire data and brain measurements achieved cross-validation Area Under the Curve classification accuracy of 0.801 for predicting headache improvement. The most highly contributing model features included questionnaires assessing psychosocial symptoms and brain structural measurements including curvature and thickness in of superior, middle, and inferior temporal, fusiform, inferior parietal, and lateral occipital regions. At baseline, those with aPTH who improved by three months had less severe symptoms of mTBI, pain catastrophizing, and anxiety than those who did not improve. Furthermore, aPTH patients whose headaches did not improve had significantly greater baseline differences in brain structure vs. HC compared to those whose headaches did improve vs. HC.