Research Reports - Prediction of headache severity (density and functional impact) after traumatic brain injury

Cephalalgia. 2013 Apr 19

Walker WC, Marwitz JH, Wilk AR, Ketchum JM, Hoffman JM, Brown AW, Lucas S

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.

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