Neuropsychiatric Predictors of Post‐Injury Headache After Mild‐Moderate Traumatic Brain Injury in Veterans

Bomyea, Jessica; Lang, Ariel J.; Delano‐Wood, Lisa; Jak, Amy J.; Hanson, Karen L.; Sorg, Scott F.; Clark, Alexandra L.; Schiehser, Dawn M.

doi:10.1111/head.12799

Cited by 18 publications

(13 citation statements)

References 69 publications

(124 reference statements)

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“…Another characteristic shared by the two PPTH subgroups is high levels of PTSD when compared to headache-free TBI subjects, despite a similar incidence of moderate and severe TBI in these distinct groups. PTSD is a common characteristic among subjects with PPTH and is often reported to correlate with headache severity and disability (47–49). A novel finding of the current study is that the interaction between PTSD level and the magnitude of the headache in the two PPTH subtypes followed opposite directions.…”

Section: Discussionmentioning

confidence: 99%

Different clinical phenotypes of persistent post-traumatic headache exhibit distinct sensory profiles

et al. 2019

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Introduction Persistent post-traumatic headache remains a poorly understood clinical entity. Although there are currently no accepted therapies for persistent post-traumatic headache, its clinical symptoms, which primarily resemble those of migraine or tension-type headache, often serve to guide treatment. However, evidence-based justification for this treatment approach remains lacking given the paucity of knowledge regarding the characteristics of these two major persistent post-traumatic headache phenotypes and their etiology. Methods We compared clinical features and quantitative sensory testing profiles between two distinct cohorts of persistent post-traumatic headache subjects that exhibited symptoms resembling either migraine (n = 15) or tension-type headache (n = 13), as well as to headache-free subjects that had suffered traumatic brain injury (n = 19), and to healthy controls (n = 10). We aimed to determine whether the two persistent post-traumatic headache subgroups could be discriminated based on additional clinical features, distinct quantitative sensory testing profiles, or the interaction of pain severity with the level of post-traumatic stress disorder. Results Persistent post-traumatic headache subjects with migraine-like symptoms reported that bright light and focused attention aggravated their pain, while stress and nervousness were reported to aggravate the headache in subjects with tension-type headache-like symptoms. Quietness was better in alleviating migraine-like persistent post-traumatic headache, while anti-inflammatory medications provided better relief in tension-type headache-like persistent post-traumatic headache. The two persistent post-traumatic headache subgroups exhibited distinct quantitative sensory testing profiles with subjects exhibiting tension-type headache-like persistent post-traumatic headache displaying a more pronounced cephalic and extracephalic thermal hypoalgesia that was accompanied by cephalic mechanical hyperalgesia. While both persistent post-traumatic headache subgroups had high levels of post-traumatic stress disorder, there was a positive correlation with pain severity in subjects with tension-type headache-like symptoms, but a negative correlation in subjects with migraine-like symptoms. Conclusions Distinct persistent post-traumatic headache symptoms and quantitative sensory testing profiles may be linked to different etiologies, potentially involving various levels of neuropathic and inflammatory pain, and if confirmed in a larger cohort, could be used to further characterize and differentiate between persistent post-traumatic headache subgroups in studies aimed to improve treatment.

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Section: Discussionmentioning

confidence: 99%

Different clinical phenotypes of persistent post-traumatic headache exhibit distinct sensory profiles

et al. 2019

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“…This is compounded by limited preventative measures and lifestyle interventions received in a deployed setting [7]. History of concussion or mild TBI has been shown to correlate with poor mental health outcomes, particularly for those who endorse PTHA [8–11]. Furthermore, it is recognized that psychiatric symptoms can make recovery more difficult [12].…”

Section: Introductionmentioning

confidence: 99%

“…Relaxation training, counseling, cognitive behavioral therapy (CBT) and behavioral therapy have demonstrated efficacy in small controlled trials and retrospective case reports in treatment of post-traumatic headache disorders [8, 13, 14]. Two studies demonstrated significant improvement in headache outcomes, general well-being and up to 50% reduction in self-reported headache days with use of CBT or behavioral therapy [14, 15].…”

Section: Introductionmentioning

confidence: 99%

Lifestyle modifications as therapy for medication refractory post-traumatic headache (PTHA) in the military population of Okinawa

2018

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ObjectiveOur aim was 1) to reduce disability, as characterized by headache frequency, duration and severity in patients with post-traumatic headache (PTHA), 2) to reduce the number of medical boards and work limitations in patients with post traumatic headache, and 3) to reduce use of medical resources and clinic visits related to headache or migraine.BackgroundModifiable risk factors for PTHA include stressful life event, sleep disturbances, and medication overuse. Cognitive-behavioral strategies, biofeedback, and relaxation therapy may have an important role in treatment and preventing progression to chronic post-traumatic headache (CPTHA). There is limited literature and a known practice gap for implementation of these techniques.Design/methodsAn IRB approved project focused on patients who were seen for PTHA and CPTHA. 1) Intervention consisted of lifestyle teaching, cognitive-behavioral therapy and biofeedback, supplemented by decreasing polypharmacy. 2) Patients were followed for 2 years and a retrospective review was conducted for 2 years prior to presentation. 3) Outcome measures included reduction in migraine intensity or frequency, improved quality of life, duty status, and decreased utilization of clinic visits.ResultsOver the course of one year, 221 patients were treated for migraines in the Naval Okinawa Neurology Clinic. Of these, 22 active duty service members and 3 Dependents suffered a mild TBI prior to onset. After intervention, there was a 36% decrease in PTHA frequency, 56% decrease in headache severity and 60% of patients had improved quality of life as compared to the 2 years prior to intervention. Twenty-four percent had reduction in polypharmacy. Appointment frequency for migraine decreased from an average of 6.8 to 2.6 per year.ConclusionsAn implemented program geared towards reducing polypharmacy was shown to improve safety, quality of life and reduce hospitalizations from the burden of migraines. Our systematic approach resulted in quality of life improvements and decreased use of medical resources.Trial registrationAuthors received the approval of NAVMED West, Okinawa Naval Hospital Institutional Review Board on January 13th, 2016. QI.2016.0021.

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“…Anxiety has also found to be linked to sleep disorders and fatigue. Sleep disorders, as well as fatigue, have been found to be predictors of PTH severity [57]. Cognitive impairment in PTH often presents with significant reductions in executive function, information processing speed, visual sensory input integration, and forgetfulness [58,59].…”

Section: Clinical Models and Overlapmentioning

confidence: 99%

Position Paper on Post-Traumatic Headache: The Relationship Between Head Trauma, Stress Disorder, and Migraine

Lambru¹,

Benemei

Andreou

et al. 2020

Pain Ther

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Traumatic brain injury (mTBI) is a major public health concern, with mild TBI (mTBI) constituting the vast majority of the injuries. Posttraumatic headache (PTH) is one of the most frequent symptoms that follow a mTBI, occurring in isolation with a tension-type or migraine phenotype, or more often as part of a complex neurobehavioural array of symptoms. The existence of PTH as a separate entity from the primary headaches is still a matter of debate. Classification issues and a lack of methodologically robust epidemiological and clinical studies have made it difficult to elucidate the mechanisms underlying acute and even more assessing the efficacy of this class of treatments are underway. The broad overlap between PTH, migraine, and PTSD suggests that research in this field should start with a re-appraisal of the diagnostic criteria, followed by methodologically sound epidemiological and clinical studies. Preclinical research should strive to create more reliable PTH models to support human neuroimaging, neurochemical, and neurogenetic studies, aiming to underpin new pathophysiological hypotheses that may expand treatment targets and improve the management of PTH patients.

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Neuropsychiatric Predictors of Post‐Injury Headache After Mild‐Moderate Traumatic Brain Injury in Veterans

Cited by 18 publications

References 69 publications

Different clinical phenotypes of persistent post-traumatic headache exhibit distinct sensory profiles

Different clinical phenotypes of persistent post-traumatic headache exhibit distinct sensory profiles

Lifestyle modifications as therapy for medication refractory post-traumatic headache (PTHA) in the military population of Okinawa

Position Paper on Post-Traumatic Headache: The Relationship Between Head Trauma, Stress Disorder, and Migraine

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