Frequency and predictors of headache in the first 12 months after traumatic brain injury: results from CENTER-TBI

Abstract

Background: Headache is a prevalent and debilitating symptom following traumatic brain injury (TBI). Large-scale, prospective cohort studies are needed to establish long-term headache prevalence and associated factors after TBI. This study aimed to assess the frequency and severity of headache after TBI and determine whether sociodemographic factors, injury severity characteristics, and pre- and post-injury comorbidities predicted changes in headache frequency and severity during the first 12 months after injury.

Methods: A large patient sample from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) prospective observational cohort study was used. Patients were stratified based on their clinical care pathway: admitted to an emergency room (ER), a ward (ADM) or an intensive care unit (ICU) in the acute phase. Headache was assessed using a single item from the Rivermead Post-Concussion Symptoms Questionnaire measured at baseline, 3, 6 and 12 months after injury. Mixed-effect logistic regression analyses were applied to investigate changes in headache frequency and associated predictors.

Results: A total of 2,291 patients responded to the headache item at baseline. At study enrolment, 59.3% of patients reported acute headache, with similar frequencies across all strata. Female patients and those aged up to 40 years reported a higher frequency of headache at baseline compared to males and older adults. The frequency of severe headache was highest in patients admitted to the ICU. The frequency of headache in the ER stratum decreased substantially from baseline to 3 months and remained from 3 to 6 months. Similar trajectory trends were observed in the ICU and ADM strata across 12 months. Younger age, more severe TBI, fatigue, neck pain and vision problems were among the predictors of more severe headache over time. More than 25% of patients experienced headache at 12 months after injury.

Conclusions: Headache is a common symptom after TBI, especially in female and younger patients. It typically decreases in the first 3 months before stabilising. However, more than a quarter of patients still experienced headache at 12 months after injury. Translational research is needed to advance the clinical decision-making process and improve targeted medical treatment for headache.

Trial registration: ClinicalTrials.gov NCT02210221.

Keywords: Brain trauma; Observational study; Post-traumatic headache; Secondary headache disorders.

Fig. 1

Frequency of patients with headache (RPQ cutoff ≥ 2) at baseline by 10-year age interval and sex

Fig. 2

a Estimated proportions of patients with headache (cutoff ≥ 2) by ER, ADM and ICU strata up to 6 months, b Estimated proportions of patients with headache (cutoff ≥ 2) by ADM and ICU strata up to 12 months, c Estimated proportions of patients with headache (cutoff ≥ 3) by ADM and ICU strata up to 12 months

Fig. 3

a Main effect and time interaction of fatigue on headache changes, b main effect and time interaction of neck pain on headache changes, c main effect and time interaction of vision problems on headache changes

Fig. 4

a Main effect and time interaction of age on headache changes, b main effect and time interaction of ISS on headache changes, c main effect and time interaction of neck pain on headache changes