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. 2017 Dec;18(1):64.
doi: 10.1186/s10194-017-0774-6. Epub 2017 Jun 26.

Post-traumatic headache in patients with minimal traumatic intracranial hemorrhage after traumatic brain injury: a retrospective matched case-control study

Chang-Ki Hong  1   2 , Yu Shik Shim  3 , Sook Young Sim  4 , Jin-Yang Joo  1 , Min A Kwon  1 , Yong Bae Kim  1 , Joonho Chung  5   6   7
Affiliations

Post-traumatic headache in patients with minimal traumatic intracranial hemorrhage after traumatic brain injury: a retrospective matched case-control study

Chang-Ki Hong et al. J Headache Pain. 2017 Dec.

Abstract

Background: No evidence is available on the risks of neurologically asymptomatic minimal traumatic intracranial hemorrhage (mTIH) in patients with traumatic brain injury (TBI) for post-traumatic headache (PTH). The purpose of this study was to investigate whether mTIH in patients with TBI was associated with PTH and to evaluate its risk factors.

Methods: Between September 2009 and December 2014, 1484 patients with TBI were treated at our institution, 57 of whom had mTIH after TBI and were include in this study. We performed propensity score matching to establish a control group among the 823 patients with TBI treated during the same period. Patients with TBI rated their headaches prospectively using a numeric rating scale (NRS). We compared NRS scores between mTIH group (n = 57) and non-mTIH group (n = 57) and evaluated risk factors of moderate-to-severe PTH (NRS ≥ 4) at the 12-month follow-up.

Results: Moderate-to-severe PTH was reported by 21.9% of patients (29.8% in mTIH group and 14.0% in non-mTIH group B, p = 0.012) at the 12-month follow-up. The mean NRS was higher in mTIH group than in non-mTIH group throughout the follow-up period (95% confidence interval [CI], 0.11 to 1.14; p < 0.05, ANCOVA). Logistic regression analysis showed that post-traumatic seizure (odds ratio, 1.520; 95% CI, 1.128-6.785; p = 0.047) and mTIH (odds ratio, 2.194; 95% CI, 1.285-8.475; p = 0.039) were independently associated with moderate-to-severe PTH at the 12-month follow-up.

Conclusions: Moderate-to-severe PTH can be expected after TBI in patients with mTIH and post-traumatic seizure. PTH occurs more frequently in patients with mTIH than in those without mTIH.

Keywords: Head trauma; Post-traumatic headache; Traumatic brain injury; Traumatic intracranial hemorrhage.

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Figures

Fig. 1
Fig. 1
Absolute standardized difference (ASD) before and after propensity score matching. ASD < 0.10 implies good balance between the two groups. GCS, Glasgow Coma Scale; TBI, traumatic brain injury
Fig. 2
Fig. 2
Mean numeric rating scale (NRS) scores of both groups. The difference in NRS scores between mTIH groups and non-mTIH group was statistically significant (95% confidence interval, 0.11 to 1.14; p < 0.05, ANCOVA)
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