Objective: To investigate the impact of having headaches prior to traumatic brain injury (TBI) on headache features and long-term patient health outcomes. Background and Methods: This was an exploratory analysis of patients with TBI who were enrolled in the American Registry for Migraine Research (ARMR), a multicenter, prospective, longitudinal patient registry composed of patients with International Classification of Headache Disorders, 3rd edition (ICHD-3)-defined headache diagnoses. The ARMR study enrolled 2,707 patients between February 1, 2016 and May 6, 2020, 565 of whom qualified for this analysis. Those with headaches prior to their TBI were compared to those without headaches prior to their TBI for ICHD-3 diagnoses, headache frequency and intensity, headache-related disability (Migraine Disability Assessment score), symptoms of anxiety (General Anxiety Disorder [GAD-7]), depression (two items from Patient Health Questionnaire-9), post-traumatic stress disorder (PTSD), cutaneous allodynia (12-item Allodynia Symptom Checklist [ASC-12]), cognitive dysfunction (Migraine Attacks Subjective Cognitive Impairments Scale [Mig-SCog]), pain interference (Patient-Reported Outcomes Measurement Information System-Pain Interference), and work productivity (Work Productivity and Activity Impairment).Results: Among 565 participants with TBI, 350 had headaches prior to their TBI. Those with pre-TBI headaches were less likely to receive a diagnosis of post-traumatic headache (PTH; 14/350 [4.0%] vs. 21/215 [9.8%], p = 0.006), even though 25.7% reported new or worsening headaches within 7 days of their TBI. Those with pre-TBI headaches had higher ASC-12 scores (2.4 ± 3.5 vs. 1.8 ± 3.4, p = 0.030), Mig-SCog scores (9.3 ± 4.7 vs. 8 ± 4.9, p = 0.004), and GAD-7 scores (6.9 ± 5.1 vs. 6.2 ± 5.4, p = 0.039), and were more likely to have a migraine diagnosis (335/350 [95.7%] vs. 192/215 [89.3%], p = 0.003). Conclusions:Those with headaches prior to TBI are less likely to receive a diagnosis of PTH. They have more severe symptoms of cutaneous allodynia, cognitive impairment,
Background: Photosensitivity, often called “photophobia” in the migraine literature, is a common and bothersome symptom for most people during their migraine attacks. This study aimed to investigate the association of photophobia severity with work productivity, activity impairment, and migraine-associated disability using data from a large cohort of patients with migraine who were enrolled into the American Registry for Migraine Research (ARMR). Methods: This study used Photosensitivity Assessment Questionnaire (PAQ) scores to investigate the relationship between photophobia severity with work productivity and activity impairment (using the Work Productivity and Activity Impairment [WPAI] questionnaire) and migraine-related disability (using the Migraine Disability Assessment [MIDAS]) among those with migraine. Summary statistics are presented as means and standard deviations for variables that were normally distributed and as medians and interquartile ranges for variables that were not normally distributed. Multiple linear regression models were developed to measure the relationships between photophobia scores with work productivity and activity impairment and migraine-associated disability, controlling for age, sex, headache frequency, headache intensity, anxiety (using the generalized anxiety disorder [GAD-7]), and depression (using the Patient Health Questionnaire [PHQ-2]). Results: One thousand eighty-four participants were included. Average age was 46.1 (SD 13.8) years, 87.2% (n = 945) were female, average headache frequency during the previous 90 days was 44.3 (SD 29.9), average headache intensity was 5.9 (SD 1.7), median PHQ-2 score was 1 (IQR 0–2), and median GAD-7 was 5 (IQR 2–8). Mean PAQ score was 0.47 (SD 0.32), and median MIDAS score was 38 (IQR 15.0–80.0). Among the 584 employed participants, 47.4% (n = 277) reported missing work in the past week because of migraine, mean overall work impairment was 42.8% (SD 26.7), mean activity impairment was 42.5% (SD 26.2), mean presenteeism score was 38.4% (SD 24.4), and median absenteeism was 0 (IQR 0–14.5). After controlling for age, sex, headache frequency, average headache intensity, PHQ-2 score, and GAD-7 score, there was a statistically significant association between photophobia scores with: a) MIDAS scores (F[7,1028] = 127.42, P < 0.001, R2 = 0.461, n = 1,036); b) overall work impairment (F[7,570] = 29.23, P < 0.001, R2 = 0.255, n = 578); c) activity impairment (F[7,570] = 27.42, P < 0.001, R2 = 0.243, n = 578); d) presenteeism (F[7,570] = 29.17, P < 0.001, R2 = 0.255, n = 578); and e) absenteeism for the zero-inflated (P = 0.003) and negative binomial (P = 0.045) model components (P < 0.001, n = 578). Conclusions: In those with migraine, severe photophobia is associated with reduced work productivity and higher presenteeism, absenteeism, activity impairment, and migraine-related disability.
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