Research Reports - Comorbidity of headache and depression after mild traumatic brain injury

Headache. 2016 Feb;56(2):323-30. doi: 10.1111/head.12762. Epub 2016 Jan 27.

Lucas S(1), Smith BM(2), Temkin N(1), Bell KR(3), Dikmen S(1), Hoffman JM(1).

OBJECTIVE: To examine headache and depression over time in individuals who
sustained mild traumatic brain injury (mTBI). Prevalence of headache and
depression early after mTBI and at 1 year postinjury as well as the relationship
between the two are evaluated.
BACKGROUND: Headache is the most common physical symptom and depression is among
the most common psychiatric diagnosis after traumatic brain injury regardless of
severity. Headache and depression have been found to be two independent factors
related to poor outcome after mTBI, yet there appears to be a paucity of research
exploring the comorbidity of these two conditions after injury.
METHOD/DESIGN: Longitudinal survey design over 1 year of 212 participants with
mTBI who were admitted to a Level 1 trauma center for observation or other system
injuries. Depression was based on a score ≥10 on the Patient Health
Questionnaire-9. Headache was based on participant report of new or
worse-than-preinjury headache since hospitalization (baseline) or within the
previous 3 months at 1 year postinjury.
RESULTS: The prevalence of headache and depression at baseline was 64% (135/212)
and 15% (31/212), respectively. The prevalence of headache and depression at 1
year was 68% (127/187) and 27% (50/187), respectively. The co-occurrence of
headache and depression increased from 11% (23/212) at baseline to 25% (46/187)
at 1 year. At 1 year, the risk ratio of individuals who had headache to be
depressed was 5.43 (95% CI 2.05-14.40) compared to those without headache
(P < .001). The corresponding risk ratio at baseline was 1.64 (95% CI .77-3.49;
P = .23).
CONCLUSIONS: While prevalence of headache is consistently high over the first
year after injury, rate of depression increased over the first year for those who
were followed. Given the high rate of comorbidity, those with headache may
develop depression over time. Evaluation for possible depression in those with
headache after mTBI should be conducted to address both conditions over the year
following injury.

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