Prediction of headache severity (density and functional impact) after traumatic brain injury: A longitudinal multicenter study. (September 2013)

• Record Type: Journal Article
• Authors: Walker, William C; Marwitz, Jennifer H; Wilk, Amber R; Ketchum, Jessica M; Hoffman, Jeanne M; Brown, Allen W; Lucas, Sylvia
• Is Part Of: Cephalalgia. Volume 33:Number 12(2013)
• Page Start: 998
• Page End: 1008
• Publication Date: 2013-09
• Subjects: Headache -- outcomes -- post-traumatic headache -- traumatic brain injury -- head injury; Headache -- Periodicals; 616.8491
• DOI: 10.1177/0333102413482197
• Languages: English
• ISSNs: 0333-1024

Abstract

Background: Headache (HA) following traumatic brain injury (TBI) is common, but predictors and time course are not well established, particularly after moderate to severe TBI. Methods: A prospective, longitudinal cohort study of HA severity post-TBI was conducted on 450 participants at seven participating rehabilitation centers. Generalized linear mixed-effects models (GLMMs) were used to model repeated measures (months 3, 6, and 12 post-TBI) of two outcomes: HA density (a composite of frequency, duration, and intensity) and HA disruptions to activities of daily living (ADL). Results: Although HA density and ADL disruptions were nominally highest during the first three months post-TBI, neither showed significant changes over time. At all time points, history of pre-injury migraine was by far the strongest predictor of both HA density and ADL disruptions (odds ratio (OR) = 8.0 and OR = 7.2, averaged across time points, respectively). Furthermore, pre-injury non-migraine HA (at three and six months post-TBI), penetrating-type TBI (at six months post-TBI), and female sex (at six and 12 months post-TBI) were each associated with an increase in the odds of a more severe HA density. Severity of TBI (post-traumatic amnesia (PTA) duration) was not associated with either outcome. Conclusion: Individuals with HA at three months after moderate-severe TBI do not improve over the ensuing nine months with respect to HA density or ADL disruptions. Those with pre-injury HA, particularly of migraine type, are at greatest risk for HA post-TBI. Other independent risk factors are penetrating-type TBI and, to a lesser degree and post-acutely only, female sex. Individuals with these risk factors should be monitored and considered for aggressive early intervention.