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

Short Title:
Model System:
TBI
Reference Type:
Journal Article
Accession No.:
Journal:
Cephalalgia.
Year, Volume, Issue, Page(s):
2013, vol. 33, issue 12, pp 998-1008
Publication Website:
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.
Author(s):
Walker WC, Marwitz JH, Wilk AR, Ketchum JM, Hoffman JM, Brown AW, Lucas S.
Author Address(es):

Some items may be available for document delivery from the National Rehabilitation Information Center. Make a note of the title and any accession number and contact NARIC at 800-346-2742 to request a copy. There is a charge for document delivery from the NARIC collection.