title: Neuropsychiatric Predictors of Post-Injury Headache After Mild-Moderate Traumatic Brain Injury in Veterans.
abstract: OBJECTIVE
  To determine differences in neuropsychiatric complaints between Veterans with mild to moderate traumatic brain injury (TBI), with and without headache, compared with Veteran controls, and to identify neuropsychiatric predictors of headache severity.
  
  
  BACKGROUND
  Mild to moderate TBI is a common occurrence in Veterans, and is frequently associated with complaints of headache. Neuropsychiatric complaints are also common among individuals who have sustained head injury, although the relationship between these factors and headache after injury is unclear. Research is needed to comprehensively determine differences between individuals with mild to moderate traumatic brain injury who differ with respect to headache, and which injury, psychological, or sleep and fatigue factors predict headache severity.
  
  
  METHODS
  A cross-sectional study compared 85 Veterans in three groups (positive for TBI and headache, positive for TBI without significant headache, and a control group) on a set of injury characteristics and neuropsychiatric variables. Correlates of headache severity were examined, and a regression model was used to identify significant independent predictors of headache severity.
  
  
  RESULTS
  Individuals with mild to moderate TBI and headache endorsed significantly greater neuropsychiatric symptoms than participants in the other groups (η(p)2  = .23-.36) Neuropsychiatric complaints, as well as presence of posttraumatic amnesia, were correlated with headache in the subsample with TBI (rs = .44-.57). When entering all predictors into a regression model, only fatigue represented a significant independent predictor of headache severity (β = .59, R2 = .35).
  
  
  CONCLUSIONS
  Rather than being a global risk factor, mild to moderate TBI was associated with poorer mental health outcomes, particularly for those who endorse headache. Findings underscore the possibility that Veterans with history of TBI who present with complaints of headache may represent a particularly vulnerable subgroup. Additionally, our findings suggest that clinical outcomes may be improved in those with neurotrauma by incorporating a focus on fatigue in treatment.
authors.affiliation: Research and Psychology Services, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.|Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Bomyea
authors.affiliation: Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA.|Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
authors.forename: Ariel J
authors.initials: AJ
authors.lastname: Lang
authors.affiliation: Research and Psychology Services, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.|Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA.|Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Delano-Wood
authors.affiliation: Research and Psychology Services, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.|Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA.|Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Jak
authors.affiliation: Research and Psychology Services, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.|Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Hanson
authors.affiliation: Research and Psychology Services, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Sorg
authors.affiliation: Research and Psychology Services, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.|Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.|San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology.
authors.forename: Alexandra L
authors.initials: AL
authors.lastname: Clark
authors.affiliation: Research and Psychology Services, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.|Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA.|Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Schiehser
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001924:Brain Concussion / Q000150:complications* / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D047830:Gulf War; D006261:Headache / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology*; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D009483:Neuropsychological Tests; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D014728:Veterans / Q000523:psychology*
keywords: headache; post-injury headache; post-traumatic headache; traumatic brain injury