title: 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.
authors: Department of Rehabilitation Medicine, University of Washington, Seattle, Washington 98195-6490, USA. jeanneh@uw.edu
authors: Jeanne M
authors: JM
authors: Hoffman
authors: Sylvia
authors: S
authors: Lucas
authors: Sureyya
authors: S
authors: Dikmen
authors: Cynthia A
authors: CA
authors: Braden
authors: Allen W
authors: AW
authors: Brown
authors: Robert
authors: R
authors: Brunner
authors: Ramon
authors: R
authors: Diaz-Arrastia
authors: William C
authors: WC
authors: Walker
authors: Thomas K
authors: TK
authors: Watanabe
authors: Kathleen R
authors: KR
authors: Bell
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000150:complications* / Q000453:epidemiology* / Q000534:rehabilitation; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D051298:Post-Traumatic Headache / Q000453:epidemiology* / Q000209:etiology*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires