Hong Chang-Ki, Joo Jin-Yang, Shim Yu Shik, Sim Sook Young, Kwon Min A, Kim Yong Bae, Chung Joonho
Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea.
Severance Institute for Vascular and Metabolic Research, Yonsei University, Seoul, Republic of Korea.
J Headache Pain. 2017 Dec;18(1):48. doi: 10.1186/s10194-017-0755-9. Epub 2017 Apr 20.
Little is known about the long-term course of headache in patients with moderate-to-severe headache due to traumatic brain injury (TBI). We evaluated the course of headache in patients with moderate-to-severe headache due to mild TBI.
Since September 2009, patients with TBI prospectively rated their headache using a numeric rating scale (NRS). From the database containing 935 patients with TBI between September 2009 and December 2013, 259 patients were included according to following criteria: (1) newly onset moderate-to-severe headache (NRS ≥ 4) due to head trauma; (2) age ≥ 15 years; (3) Glasgow Coma Scale ≥ 13; (4) transient loss of consciousness ≤ 30 min; and (5) radiographic evaluation, such as computed tomography or magnetic resonance image. We evaluated initial and follow-up NRS scores to determine the significance of NRS changes and identified risk factors for moderate-to-severe headache at 36-month follow-up.
At 36-month follow-up, 225 patients (86.9%) reported improved headache (NRS ≤ 3) while 34 (13.1%) reported no improvement. The NRS scores were significantly decreased within a month (P < 0.001). The follow-up NRS scores at 12-, 24-, and 36-months were lower than those at one month (P < 0.001). Multiple logistic regression analysis showed that post-traumatic seizure (odds ratio, 2.162; 95% CI, 1.095-6.542; P = 0.041) and traumatic intracranial hemorrhage (odds ratio, 2.854; 95% CI, 1.241-10.372; P = 0.024) were independent risk factors for moderate-to-severe headache at 36-month follow-up.
The course of headache in patients with mild TBI continuously improved until 36-month follow-up. However, 13.1% of patients still suffered from moderate-to-severe headache at 36-month follow-up, for whom post-traumatic seizure and traumatic intracranial hemorrhage might be risk factors.
对于因创伤性脑损伤（TBI）导致中重度头痛患者的头痛长期病程，人们了解甚少。我们评估了因轻度TBI导致中重度头痛患者的头痛病程。
自2009年9月起，TBI患者使用数字评定量表（NRS）对其头痛进行前瞻性评分。从2009年9月至2013年12月包含935例TBI患者的数据库中，根据以下标准纳入259例患者：（1）因头部外伤新发性中重度头痛（NRS≥4）；（2）年龄≥15岁；（3）格拉斯哥昏迷量表≥13；（4）短暂意识丧失≤30分钟；（5）影像学评估，如计算机断层扫描或磁共振成像。我们评估初始和随访时的NRS评分以确定NRS变化的意义，并确定36个月随访时中重度头痛的危险因素。
在36个月随访时，225例患者（86.9%）报告头痛改善（NRS≤3），而34例（13.1%）报告无改善。NRS评分在1个月内显著降低（P<0.001）。12个月、24个月和36个月时的随访NRS评分低于1个月时（P<0.001）。多因素逻辑回归分析显示，创伤后癫痫（比值比，2.162；95%可信区间，1.095 - 6.542；P = 0.041）和创伤性颅内出血（比值比，2.854；95%可信区间，1.241 - 10.372；P = 0.024）是36个月随访时中重度头痛的独立危险因素。
轻度TBI患者的头痛病程在36个月随访前持续改善。然而，在36个月随访时，13.1%的患者仍患有中重度头痛，创伤后癫痫和创伤性颅内出血可能是这些患者的危险因素。
