Abstract
BackgroundPost-traumatic headache (PTH) is a common symptom following mild traumatic brain injury (mTBI). Patients at risk to develop acute PTH (aPTH) and further persistent PTH (pPTH) need to be recognized.MethodsThis is a one-year follow-up of 127 patients with mTBI, aged 18 to 68, referred to outpatient clinic in the Helsinki University Hospital. Symptoms were assessed at the emergency department (ED), with structured interview at outpatient clinic visit and with Rivermead post-concussion symptom questionnaire at one, three, and 12 months after injury. Psychiatric disorders were assessed with Structured Clinical Interview for DSM-IV Axis I disorders at 3-4 months and return to work (RTW) from patient records.ResultsAt one month, 77/127 patients (61%) had aPTH. According to multiple logistic regression analysis, risk factors for aPTH were headache at the emergency department (ED) (OR 5.43), other pain (OR 3.19), insomnia (OR 3.23), and vertigo (OR 5.98). At three months, 17 patients (22% of aPTH patients) had developed pPTH, and at one year, 4 patients (24% of pPTH patients) still presented with pPTH. Risk factors for pPTH at three months were older age (OR 1.06) and current insomnia (OR 12.3). The frequency of psychiatric disorders did not differ between the groups. pPTH patients performed worse on their RTW.ConclusionsRisk factors for aPTH were insomnia, headache at ED, other pain, and vertigo and for pPTH, insomnia and older age. RTW rate was lower among pPTH patients.
Highlights
Traumatic brain injury (TBI) is estimated to affect 69 million individuals per year [1]
Previous studies and our findings indicate that pathological brain imaging findings are not likely an essential risk factor for Post-traumatic headache (PTH)
In a study by Stulemeijer and colleagues, low levels of post-concussion symptoms indicated good recovery and return to work (RTW) [30]. In line with these studies, we identified that our persistent PTH (pPTH) patients were less likely to return to full-time work at three months compared with acute PTH (aPTH)- and non-PTH patients [9, 10]
Summary
Traumatic brain injury (TBI) is estimated to affect 69 million individuals per year [1]. Mild TBI (mTBI) represents 70-90% of all TBIs [2,3,4]. Post-traumatic headache (PTH) is one of the most common symptoms following TBI [5,6,7] and is more common after mTBI than moderate or severe TBI [8]. A subgroup of patients experience prolonged post-traumatic symptoms including headache, which can cause long-term disability and delayed return to work [9,10,11]. During the first three months from onset, PTH is defined as acute, and beyond that, persistent [12]. Post-traumatic headache (PTH) is a common symptom following mild traumatic brain injury (mTBI). Patients at risk to develop acute PTH (aPTH) and further persistent PTH (pPTH) need to be recognized
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