Natural History of Headache Five Years after Traumatic Brain Injury

Abstract

Headache is one of the most frequently reported symptoms following traumatic brain injury (TBI). Little is known about how these headaches change over time. We describe the natural history of headache in individuals with moderate to severe TBI over 5 years after injury. A total of 316 patients were prospectively enrolled and followed at 3, 6, 12, and 60 months after injury. Individuals were 72% male, 73% white, and 55% injured in motor vehicle crashes, with an average age of 42. Pre-injury headache was reported in 17% of individuals. New or worse headache prevalence remained consistent with at least 33% at all time points. Incidence was >17% at all time points with first report of new or worse headache in 20% of participants at 60 months. Disability related to headache was high, with average headache pain (on 0-10 scale) ranging from 5.5 at baseline to 5.7 at 60 months post-injury, and reports of substantial impact on daily life across all time points. More than half of classifiable headaches matched the profile of migraine or probable migraine. Headache is a substantial problem after TBI. Results suggest that ongoing assessment and treatment of headache after TBI is needed, as this symptom may be a problem up to 5 years post-injury.

The course of headache in patients with moderate-to-severe headache due to mild traumatic brain injury: a retrospective cross-sectional study

“…In fact, it was reported that disability related to post-traumatic headache was high with an average NRS ranging from 5.5 at baseline to 5.7 at 60-month follow-up [14]. Moderate-to-severe TBI makes post-traumatic headache worse compared to mild TBI [23].…”

Posttraumatic Headache: Classification by Symptom‐Based Clinical Profiles

“…4,5,11,14 This number will vary significantly depending on the original questions posed to the patients, but usually is a problem with questionnairebased diagnostic queries. 4,5,11,14 This number will vary significantly depending on the original questions posed to the patients, but usually is a problem with questionnairebased diagnostic queries.…”

“…Unlike traumatic tissue injury, which resolves with time, the natural history of PTH shows itself to be remarkably persistent. [3][4][5] In addition, although many existing headache medications used for primary headache disorders are prescribed to those with PTH, many have noted that few people respond well to them, and no medications have adequately established efficacy in prospective studies. 6 Furthermore, symptom profiles of patients with PTH are heterogeneous, and the profiles of multiple primary headache conditions appear to predominate concurrently in many of these individuals 7,8 and thus do not sit well or are not classifiable within existing primary diagnostic criteria.…”

“…These distributions of headache type were almost exactly the same when all subjects were reclassified to include those with a prior history of problematic headache. 4,5,11 Using the same questionnaire and headache definitions in a study of mTBI 4 at 3 months after injury, PTH were classified as migraine or probable migraine in 49% with persistence of headache type at 1 year (50%). TTH type was present in 37% at 3 months and 32% at 1 year.…”

“…Many of these studies report on "unclassifiable" headaches. 4,5,11,14 This number will vary significantly depending on the original questions posed to the patients, but usually is a problem with questionnairebased diagnostic queries. Many unclassifiable headaches did not meet the criteria of the duration of headache, eg, 4-72 hours for "migraine" type, or had features of both migraine and tension-type headaches, which may have been better captured with an in-person interview.…”