Article

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 (beta [SE]=.61 [.07], P<.001), as compared with no TBI,
but not in longitudinal analyses (beta [SE]=.09 [.07], P=.20). Moderate/severe
TBI was significantly associated with greater headache severity in both
cross-sectional (beta [SE]=.66 [.09], P<.001) and longitudinal analyses (beta
[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.
CI - Published by Elsevier Inc.

Langue : ANGLAIS