Natural history of headache after traumatic brain injury

Abstract

Headache is one of the most common persisting symptoms after traumatic brain injury (TBI). Yet there is a paucity of prospective longitudinal studies of the incidence and prevalence of headache in a sample with a range of injury severity. We sought to describe the natural history of headache in the first year after TBI, and to determine the roles of prior history of headache, sex, and severity of TBI as risk factors for post-traumatic headache. A cohort of 452 acute, consecutive patients admitted to inpatient rehabilitation services with TBI were enrolled during their inpatient rehabilitation from February 2008 to June 2009. Subjects were enrolled across 7 acute rehabilitation centers designated as TBI Model Systems centers. They were prospectively assessed by structured interviews prior to inpatient rehabilitation discharge, and at 3, 6, and 12 months after injury. Results of this natural history study suggest that 71% of participants reported headache during the first year after injury. The prevalence of headache remained high over the first year, with more than 41% of participants reporting headache at 3, 6, and 12 months post-injury. Persons with a pre-injury history of headache (p<0.001) and females (p<0.01) were significantly more likely to report headache. The incidence of headache had no relation to TBI severity (p=0.67). Overall, headache is common in the first year after TBI, independent of the severity of injury range examined in this study. Use of the International Classification of Headache Disorders criteria requiring onset of headache within 1 week of injury underestimates rates of post-traumatic headache. Better understanding of the natural history of headache including timing, type, and risk factors should aid in the design of treatment studies to prevent or reduce the chronicity of headache and its disruptive effects on quality of life.

FIG. 1.

Incidence and cumulative incidence of total headache (HA) and frequent HA after traumatic brain injury (TBI; n=452). Total HA incidence is the proportion of cases ascertained with HA for the first time after TBI at each time point. The values underestimate the true incidence because not all participants were assessed at each time point.

FIG. 2.

Prior history of headache as a determinant of post-traumatic headache (PTH). All time points category includes the percentage of participants who reported headache (HA) at 3, 6, and 12 months post-injury. Some time points category includes reports of HA at one or two, but not all three time points (chi-square=25.1; p<0.001).

FIG. 3.

Gender as a determinant of post-traumatic headache (PTH). All time points category includes reports of headache (HA) at 3, 6, and 12 months post-injury. Some time points category includes reports of HA at one or two, but not all three time points (chi-square=13.5; p<0.01).

FIG. 4.

Severity of traumatic brain injury (TBI) as a determinant of post-traumatic headache (PTH). All time points category includes reports of headache (HA) at 3, 6, and 12 months post-injury. Some time points category includes reports of HA at one or two, but not all three time points (chi-square=2.3; p=0.67).