Post-traumatic headache after mild traumatic brain injury in a one-year follow up study – risk factors and return to work

Abstract

Background Post-traumatic headache (PTH) is a common symptom following mild traumatic brain injury (mTBI). Patients at risk to develop acute PTH (aPTH) and further persistent PTH (pPTH) need to be recognized. Methods This is a one-year follow-up of 127 patients with mTBI, aged 18 to 68, referred to outpatient clinic in the Helsinki University Hospital. Symptoms were assessed at the emergency department (ED), with structured interview at outpatient clinic visit and with Rivermead post-concussion symptom questionnaire at one, three, and 12 months after injury. Psychiatric disorders were assessed with Structured Clinical Interview for DSM-IV Axis I disorders at 3-4 months and return to work (RTW) from patient records. Results At one month, 77/127 patients (61%) had aPTH. According to multiple logistic regression analysis, risk factors for aPTH were headache at the emergency department (ED) (OR 5.43), other pain (OR 3.19), insomnia (OR 3.23), and vertigo (OR 5.98). At three months, 17 patients (22% of aPTH patients) had developed pPTH, and at one year, 4 patients (24% of pPTH patients) still presented with pPTH. Risk factors for pPTH at three months were older age (OR 1.06) and current insomnia (OR 12.3). The frequency of psychiatric disorders did not differ between the groups. pPTH patients performed worse on their RTW. Conclusions Risk factors for aPTH were insomnia, headache at ED, other pain, and vertigo and for pPTH, insomnia and older age. RTW rate was lower among pPTH patients.

Post-Traumatic Headache in Children after Minor Head Trauma: Incidence, Phenotypes, and Risk Factors

“…In studies conducted on adults, it is more common as a result of a MHT than of a moderate or severe trauma [ 16 ]. Although not always unanimously present among different studies, preexisting conditions such as female sex, familiarity for headache and migraine, history of mental health issues, and insomnia have been considered as risk factors, as well as post-traumatic anxiety and depression symptoms, an immediate headache, and vertigo [ 17 , 18 , 19 , 20 , 21 , 22 ]. It may present as an acute (if it lasts less than 3 months) or chronic form.…”

The prevalence of persistent post-traumatic headache in adult civilian traumatic brain injury: a systematic review and meta-analysis on the past 14 years

“…68 Therefore, the consideration of sociodemographic factors could have particular relevance in understanding better sex and gender differences. Furthermore, the presence of insomnia or other pain conditions, 48,93 which have been identified as important predictors of PTH after TBI, were not measured or controlled in most of the studies included in our meta-analysis. Because the assessment of such confounders and other comorbidities is not frequently conducted in PTH prevalence studies, future research should incorporate these measures to improve rigor and precision of the results.…”

Post-Traumatic Headache: A Review of Prevalence, Clinical Features, Risk Factors, and Treatment Strategies

“…In individuals with PTH associated with blast trauma most headaches were migraine-like [22]; • Many patients (27 to 75%) experience more than one type of headache [25,26]; • Rarely, PTH symptoms mimic other primary headache disorders, such as trigeminal autonomic cephalgias, cluster headache [27], short-lasting unilateral headache with cranial autonomic symptoms [48], and paroxysmal hemicrania [49], as well as hemicrania continua [50]; PTH may be classified into non-specific PTH, chronic daily headache (CDH), chronic migraine, and chronic tension-type headache [53,54].…”