Archives of Physical Medicine and Rehabilitation
Volume 86, Issue 9 , Pages 1793-1800, September 2005

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.

  • William C. Walker, MD

      Affiliations

    • Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA
    • Defense and Veterans Brain Injury Center, Washington, DC
    • Corresponding Author InformationReprint requests to William C. Walker, MD, MCV Campus, PO Box 980661, Richmond, VA 23298-0661
    • ,
  • Ronald T. Seel, PhD

      Affiliations

    • Crawford Research Institute, Shepherd Center, Atlanta, GA
    • ,
  • Glenn Curtiss, PhD

      Affiliations

    • James A. Haley Veterans Hospital, Tampa, FL
    • Department of Psychiatry and Behavioral Medicine, University of South Florida, Tampa, FL
    • Defense and Veterans Brain Injury Center, Washington, DC
    • ,
  • Deborah L. Warden, MD

      Affiliations

    • Defense and Veterans Brain Injury Center, Washington, DC
    • Walter Reed Army Medical Center, Washington, DC
    • Uniformed Services University of the Health Sciences, Bethesda, MD

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.

Design

Cohort study.

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.

Key Words:  Anxiety , Brain injuries , Depression , Headache , Rehabilitation

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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.

PII: S0003-9993(05)00231-5

doi:10.1016/j.apmr.2004.12.042

Archives of Physical Medicine and Rehabilitation
Volume 86, Issue 9 , Pages 1793-1800, September 2005

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