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Citation
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Suri P, Stolzmann K, Iverson KM, Williams R, Meterko M, Yan K, Gormley K, Pogoda TK. Arch. Phys. Med. Rehabil. 2017; 98(11): 2118-2125.e1. |
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Affiliation
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Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, US. |
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Abstract
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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: 2566 Veterans who completed a mail follow-up survey an average of 3 years after a comprehensive TBI evaluation (CTBIE). 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 (ß [SE]= 0.61[0.07], p<0.001), as compared to no TBI, but not in longitudinal analyses (ß [SE]= 0.09[0.07], p=0.20). Moderate/severe TBI was significantly associated with greater headache severity in both cross-sectional (ß [SE]= 0.66[0.09], p<0.001) and longitudinal analyses (ß [SE]= 0.18[0.09], p=0.04).
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. This study found no association 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.
Copyright © 2017. Published by Elsevier Inc.
Language: en |