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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 05, 2017
Footnotes
Supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development (HSR&D) Services Investigator Initiated Research (grant nos. 11-078, 11-358); the VA Puget Sound Health Care System and a VA Rehabilitation Research and Development Career Development Award; an HSR&D Career Development Award (CDA 10-029) and a Presidential Early Career Award for Scientists and Engineers (US 14-275). This material is also the result of work supported with resources and the use of facilities at the VA Boston Healthcare System. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the United States Government.
Disclosures: none.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
