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Associations Between Traumatic Brain Injury History and Future Headache Severity in Veterans: A Longitudinal Study

      Abstract

      Objective

      To determine whether traumatic brain injury (TBI) history is associated with worse headache severity outcomes.

      Design

      Prospective cohort study.

      Setting

      Department of Veterans Affairs (VA) outpatient clinics.

      Participants

      Veterans (N=2566) who completed a mail follow-up survey an average of 3 years after a comprehensive TBI evaluation (CTBIE).

      Interventions

      Not applicable.

      Main Outcome Measures

      The presence or absence of TBI, and TBI severity were evaluated by a trained clinician and classified according to VA/Department of Defense clinical practice guidelines. Headache severity was evaluated at both the baseline CTBIE assessment and 3-year follow-up using a 5-level headache score ranging from 0 (“none”) to 4 (“very severe”) based on headache-associated activity interference in the past 30 days. We examined associations of mild and moderate/severe TBI history, as compared to no TBI history, with headache severity in cross-sectional and longitudinal analyses, with and without adjustment for potential confounders.

      Results

      Mean headache severity scores were 2.4 at baseline and 2.3 at 3-year follow-up. Mild TBI was associated with greater headache severity in multivariate-adjusted cross-sectional analyses (β [SE]=.61 [.07], P<.001), as compared with no TBI, but not in longitudinal analyses (β [SE]=.09 [.07], P=.20). Moderate/severe TBI was significantly associated with greater headache severity in both cross-sectional (β [SE]=.66 [.09], P<.001) and longitudinal analyses (β [SE]=.18 [.09], P=.04).

      Conclusions

      Headache outcomes are poor in veterans who receive VA TBI evaluations, irrespective of past TBI exposure, but significantly worse in those with a history of moderate/severe TBI. No association was found between mild TBI and future headache severity in veterans. Veterans with headache presenting for TBI evaluations, and particularly those with moderate/severe TBI, may benefit from further evaluation and treatment of headache.

      Keywords

      List of abbreviations:

      CTBIE (comprehensive traumatic brain injury evaluation), mTBI (mild traumatic brain injury), OEF (Operation Enduring Freedom), OIF (Operation Iraqi Freedom), OND (Operation New Dawn), TBI (traumatic brain injury), VA (Veterans Affairs)
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