Research Reports - A longitudinal study of headache trajectories in the year following mild tBI

Arch Phys Med Rehabil. 2015 Jul 25

Sawyer K(1), Bell KR(2), Ehde D(3), Temkin N(4), Dikmen S(5), Williams RM(6),
Dillworth T(2), Hoffman JM(2)

OBJECTIVE: To examine headache trajectories among persons with mild Traumatic
Brain Injury (mTBI) in the year following injury, and the relationship of
headache trajectory to PTSD at one year post injury.
DESIGN: Prospective, Longitudinal study SETTING: Participants were recruited
through a university medical center and participated in follow-up assessments by
PARTICIPANTS: 212 prospectively enrolled individuals within one week of mTBI who
were hospitalized for observation or other system injuries. Participants were
assessed at baseline, three, six, and twelve months post-injury.
INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: Participants rated average
headache pain intensity using the 0-10 numeric rating scale at each assessment
period. The PTSD Checklist - Civilian Version (PCL-C) was completed at twelve
months post-injury.
RESULTS: Latent Class Growth Analysis produced a four trajectory group model,
with groups labeled Resolved, Worsening, Improving, and Chronic. Multivariate
regression modeling revealed that younger age and premorbid headache correlated
with membership in worse trajectory groups (Worsening and Chronic; p<.001).
Univariate regression revealed a significant association between PTSD and
membership in worse trajectory groups (p<.001).
CONCLUSIONS: Headache is common in the year following mTBI, with younger people,
persons who previously had headaches, and persons with PTSD more likely to report
Chronic or Worsening headache. Further research is needed to examine whether PTSD
symptoms exacerbate headaches, or whether problematic headache symptoms
exacerbate PTSD.

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