Original article
Headache After Moderate and Severe Traumatic Brain Injury: A Longitudinal Analysis

Presented in part to the American Academy of Physical Medicine and Rehabilitation, November 2002, Orlando, FL.
https://doi.org/10.1016/j.apmr.2004.12.042Get rights and content

Abstract

Walker WC, Seel RT, Curtiss G, Warden DL. Headache after moderate and severe traumatic brain injury: a longitudinal analysis.

Objectives

To measure longitudinally headache (HA) after moderate and severe traumatic brain injury (TBI) and to examine potential association with demographic, injury, and psychologic factors.

Setting

Four Veterans Administration rehabilitation facilities (Minneapolis, Palo Alto, Richmond, Tampa) within the Defense and Veterans Brain Injury Center.

Participants

Consecutive patients (military or veteran beneficiaries) with moderate or severe TBI (N=109) who during acute rehabilitation consented to data collection and who completed 6- and 12-month follow-up evaluations.

Interventions

Not applicable.

Main Outcome Measures

HA frequency, location, type, and incapacitation levels measured during prospective neurologic assessments.

Results

Nearly 38% (41/109) of patients had acute posttraumatic headache (PTHA) symptoms; most often in a frontal location (20/41), most often of daily frequency (31/41), and showing no relation to injury severity, emotional, or demographic variables. Postacutely, PTHA symptom severity declined within the group. Better individual improvement was associated with less anxiety and depression at 6-month follow-up. Almost all subjects (21/22) with PTHA symptoms that persisted into the 6-month follow-up period reported symptoms again at 12-month follow-up.

Conclusions

PTHA severity in this sample of persons with moderate and severe TBI showed a pattern of improvement that leveled off by 6 months posthospitalization.

Section snippets

Setting

This multicenter study was conducted by using acute rehabilitation and follow-up patient data derived from the Defense and Veterans Brain Injury Center (DVBIC). Study procedures followed protocol and accord with the ethical standards of the local institutional review board of each participating center. Participating were 4 Commission on Accreditation of Rehabilitation Facilities24–accredited Veterans Affairs medical center (VAMC) brain injury units located in Richmond, VA; Tampa, FL;

Case Occurrence and Characteristics of Acute PTHA

The case occurrence rate of acute PTHA was derived from the HA measures collected during acute rehabilitation. Almost 38% (41/109) of the sample was identified as having HA symptoms of any frequency or severity postinjury. Daily HA frequency was observed in 31 subjects (28% of the sample). About 6% reported experiencing HA weekly, and only 2% reported HA as occurring monthly or less. Thus, 62% (68/109) of patients did not experience HA during the hospital recovery period after moderate or

Discussion

The results of the present investigation expand on the research literature on HA after moderate and severe TBI. Descriptive data are provided on the frequency, characteristics, and course of PTHA, as well as the frequency and course of delayed-onset HA. These data provide reference points for clinical programs and for future research on HA after moderate and severe TBI. Major strengths of the study include prospective data collection, longitudinal design, quantitative HA measures, face-to-face

Conclusions

The HA rates reported here after moderate and severe TBI provide a reference for both clinicians and researchers. HA symptoms were shown to be common and were identified in 60% of this study cohort during the first year after regaining consciousness. During the acute PTHA period of hospitalization, 38% had HA of any frequency and 28% had HA of daily frequency. Longitudinally, PTHA symptoms showed a pattern of improvement that leveled off by 6 months posthospitalization. About 20% of the cohort

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    Supported by the Defense and Veterans Brain Injury Center through the Henry M. Jackson Foundation for the Advancement of Military Medicine and the Uniformed Services University of the Health Sciences (grant no. MDA 905-03-2-0003).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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