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

Cephalalgia. 2013 Sep;33(12):998-1008

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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