Research Reports - Study of headache trajectories in the year after mild traumatic brain injury

Arch Phys Med Rehabil. 2015 Nov;96(11):2000-6. doi: 10.1016/j.apmr.2015.07.006.
Epub 2015 Jul 26.

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

OBJECTIVE: To examine headache trajectories among persons with mild traumatic
brain injury (MTBI) in the year after injury and the relation of headache
trajectory to posttraumatic stress disorder (PTSD) at 1 year postinjury.
DESIGN: Prospective, longitudinal study.
SETTING: Participants were recruited through a university medical center and
participated in follow-up assessments by telephone.
PARTICIPANTS: Prospectively enrolled individuals (N=212) within 1 week of MTBI
who were hospitalized for observation or other system injuries. Participants were
assessed at baseline and 3, 6, and 12 months postinjury.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Participants rated average headache pain intensity using
the 0 to 10 numerical rating scale at each assessment period. The PTSD
Checklist-Civilian Version was completed at 12 months postinjury.
RESULTS: Latent class growth analysis produced a 4-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 the worse trajectory groups (worsening and chronic; P<.001).
Univariate regression revealed a significant association between PTSD and
membership in the worse trajectory groups (P<.001).
CONCLUSIONS: Headache is common in the year after 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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