Disability and chronic posttraumatic headache.

OBJECTIVE

To test the hypothesis that chronic posttraumatic headache is associated with greater severity and psychological distress than headache of nontraumatic origin.

METHODS

Two hundred eighty-nine consecutive patients with chronic headache attending a university headache clinic were evaluated. Questionnaires about headache symptoms, quality of life (Medical Outcome Survey SF-36 Health Survey), and psychological distress were completed.

RESULTS

Frequent headache (>4 days per week) occurred more often with traumatic (84%) than nontraumatic headache (60%). Traumatic headache resulted in greater reduced activity (3.31 +/- 1.06 days per week versus 2.62 +/- 1.11 days per week with nontraumatic headache; P<.001) and complete disability (2.89 +/- 1.17 days per week versus 2.25 +/- 1.17 days per week with nontraumatic headache; P<.001). Physical function was also rated significantly lower in patients with traumatic headache (SF-36 score: 59.8 +/- 27.7 versus 71.6 +/- 26.4 with nontraumatic headache; P<.01). These differences were not attributable to differences in headache frequency or gender between patients with traumatic and nontraumatic headache. Psychological symptoms were similar between patients with traumatic and nontraumatic chronic headache.

CONCLUSIONS

Chronic traumatic headache is associated with increased headache frequency and disability compared with nontraumatic headache. Headache evaluation should include an investigation for origin of headache and consideration for more aggressive treatment in patients with traumatic headache.