Longitudinal Study of Headache Trajectories in the Year After Mild Traumatic Brain Injury: Relation to Posttraumatic Stress Disorder Symptoms

Publication date: November 2015
Source:Archives of Physical Medicine and Rehabilitation, Volume 96, Issue 11
Author(s): Kathryn Sawyer, Kathleen R. Bell, Dawn M. Ehde, Nancy Temkin, Sureyya Dikmen, Rhonda M. Williams, Tiara Dillworth, Jeanne M. Hoffman
ObjectiveTo examine headache trajectories among persons with mild traumatic brain injury (MTBI) in the year after injury and the relation of headache trajectory to posttraumatic stress disorder (PTSD) at 1 year postinjury.DesignProspective, longitudinal study.SettingParticipants were recruited through a university medical center and participated in follow-up assessments by telephone.ParticipantsProspectively enrolled individuals (N=212) within 1 week of MTBI who were hospitalized for observation or other system injuries. Participants were assessed at baseline and 3, 6, and 12 months postinjury.InterventionsNot applicable.Main Outcome MeasuresParticipants rated average headache pain intensity using the 0 to 10 numerical rating scale at each assessment period. The PTSD Checklist-Civilian Version was completed at 12 months postinjury.ResultsLatent class growth analysis produced a 4-trajectory group model, with groups labeled resolved, worsening, improving, and chronic. Multivariate regression modeling revealed that younger age and premorbid headache correlated with membership in the worse trajectory groups (worsening and chronic; P<.001). Univariate regression revealed a significant association between PTSD and membership in the worse trajectory groups (P<.001).ConclusionsHeadache is common in the year after MTBI, with younger people, persons who previously had headaches, and persons with PTSD more likely to report chronic or worsening headache. Further research is needed to examine whether PTSD symptoms exacerbate headaches or whether problematic headache symptoms exacerbate PTSD.



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