Psychiatric and cognitive comorbidities of persistent post-traumatic headache attributed to mild traumatic brain injury

Abstract

Objective To investigate the association of psychiatric and cognitive comorbidities with persistent post-traumatic headache (PTH) attributed to mild traumatic brain injury (TBI). Methods A total of 100 patients with persistent PTH attributed to mild TBI and 100 age- and gender-matched healthy controls free of mild TBI were enrolled between July 2018 and June 2019. Quality of sleep was evaluated using the Pittsburgh Sleep Quality Index, while symptoms of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Cognitive impairment was evaluated using the Montreal Cognitive Assessment questionnaire, while post-traumatic stress disorder (PTSD) was assessed using the Harvard Trauma Questionnaire. Results In 100 patients with persistent PTH, 85% reported poor quality sleep, compared with 42% of healthy controls (P < 0.01). The relative frequency of probable to high risk of anxiety was 52% in the persistent PTH group vs. 8% in healthy controls (P < 0.01), while the relative frequency of probable to high risk of depression was 42% in the persistent PTH group vs. 2% in healthy controls (P < 0.01). Furthermore, 27% of the patients with persistent PTH had mild cognitive impairment while 10% had probable PTSD. Conclusions Poor quality of sleep as well as symptoms suggestive of anxiety and depression were more common in patients with persistent PTH than healthy controls. Clinicians should screen patients with persistent PTH for these comorbidities and develop treatment plans that account for their presence.

Total tenderness score and pressure pain thresholds in persistent post-traumatic headache attributed to mild traumatic brain injury

“…The study design has been described in detail elsewhere [ 2 , 18 ]. In brief, 100 patients with persistent post-traumatic headache and 100 age- and gender-matched healthy controls were enrolled.…”

“…Conditions associated with persistent post-traumatic headache were evaluated using the following self-report instruments: the 19-item Pittsburg Sleep Quality Index (PSQ-I) to evaluate quality of sleep and the 14-item Hospital Anxiety and Depression Scale (HADS) to screen for anxiety and/or depression [ 20 , 21 ]. The range of the scales and interpretation of the results in the present study populations have been described elsewhere [ 18 ]. In addition, the presence and severity of cutaneous allodynia was assessed using the 12-item Allodynia Symptom Checklist (ASC-12) [ 22 ].…”

“…In addition, the proportion of patients with mild, moderate, or severe cutaneous allodynia was 23%, 17%, and 6%, respectively. Additional characteristics of the patient population have been published elsewhere and are also summarized in Table 2 [2,18].…”

Cognitive Impairment in Primary and Secondary Headache Disorders

“…A retrospective observational study of 122 athletes with a mean age of 19 years found that PTH was associated with worse performance in overall cognitive, memory, attention, and processing tests adjusting for baseline cognitive function and other post-concussion symptoms [136]. In a case-control study of 100 patients with persistent PTH attributed to mild TBI and 100 healthy controls without a history of TBI, PTH was associated with increased risk of poor sleep quality (85 vs 42%), anxiety (52 vs 8%), depression (42 vs 2%), and mild cognitive impairment assessed with the MoCA (27%) [137]. However, the study did not include participants with mild TBI without PTH [137].…”

“…In a case-control study of 100 patients with persistent PTH attributed to mild TBI and 100 healthy controls without a history of TBI, PTH was associated with increased risk of poor sleep quality (85 vs 42%), anxiety (52 vs 8%), depression (42 vs 2%), and mild cognitive impairment assessed with the MoCA (27%) [137]. However, the study did not include participants with mild TBI without PTH [137]. The observed association between PTH and sleep disturbances is consistent with prior studies and contributes to worse performance on memory testing [136,138].…”