Division of Headache & Facial Pain, Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, California, USA.
J Headache Pain. 2020 Feb 7;21(1):12. doi: 10.1186/s10194-020-1080-2.
To explore naturally occurring clinical subgroups of post-traumatic headache.
Persistent post-traumatic headache (PTH) is defined as a headache developing within 7 days of an injury that lasts for greater than 3 months. However, there is no evidence available from the International Classification of Headache Disorders (ICHD) based classification between persistent and acute PTH based on clinical phenotypes.
We conducted a retrospective study using the Stanford Research Repository Cohort Discovery Tool. We reviewed 500 electronic patient charts between January 2015 to September 2019 using inclusion criteria of adults older than 18 years with a diagnosis of PTH. The following variables were extracted from each patient's chart: diagnosis of PTH as dependent variable, and predictor variables as age, sex, history of migraine, loss of consciousness during head injury, pre-existing psychological history, duration of PTH and new PTH-associated comorbidities (e.g. new onset vertigo, post-traumatic stress disorder). Logistic regression was employed to identify clinical phenotypes predicting persistent PTH. All predictor variables were tested in one block to determine their predictive capacity while controlling for other predictors in the model. Two-step cluster analysis was conducted to identify naturally occurring PTH subgroups.
A total of 300 patients were included (150 acute, 150 persistent PTH) with a median age of 47 years (IQR 31, 59) and female: male ratio of 2.7:1. Two hundred patients were excluded due to misdiagnoses. Pre-existing psychological history (standardized beta 0.16), history of migraine (0.20), new PTH-associated comorbidities (0.23) and medication overuse (0.37) statistically significantly predicted the presence of persistent PTH (p < 0.0001). Clustering analysis revealed PTH subgrouping comparable to ICHD-based classification: 140 patients in Cluster 1 (76% persistent PTH) and 160 patients in Cluster 2 (83% acute PTH). Four distinct clusters were found within persistent PTH.
Pre-existing psychological history, history of migraine, new PTH-associated comorbidities and medication overuse predicted the occurrence of persistent PTH as well as two naturally occurring PTH clusters correlating to acute and persistent PTH. Management emphasis should focus on these phenotypes.
探索创伤后头痛的自然临床亚组。
持续性创伤后头痛（PTH）定义为损伤后 7 天内发生的头痛，持续时间超过 3 个月。然而，基于国际头痛疾病分类（ICHD）的分类，没有证据表明基于临床表型可以将持续性和急性 PTH 区分开来。
我们使用斯坦福研究资源库队列发现工具进行了一项回顾性研究。我们使用纳入标准为年龄大于 18 岁、有 PTH 诊断的成年人，对 2015 年 1 月至 2019 年 9 月的 500 份电子病历进行了审查。从每位患者的病历中提取以下变量：PTH 诊断为因变量，年龄、性别、偏头痛史、头部受伤时意识丧失、既往心理病史、PTH 持续时间和新的 PTH 相关合并症（如新发性眩晕、创伤后应激障碍）为预测变量。采用逻辑回归确定预测持续性 PTH 的临床表型。所有预测变量均在一个块中进行测试，以确定它们的预测能力，同时控制模型中的其他预测变量。进行两步聚类分析以确定自然发生的 PTH 亚组。
共纳入 300 例患者（急性 PTH 150 例，持续性 PTH 150 例），中位年龄为 47 岁（IQR 31，59），女性与男性比例为 2.7:1。由于误诊，有 200 例患者被排除在外。既往心理病史（标准化β 0.16）、偏头痛史（0.20）、新的 PTH 相关合并症（0.23）和药物滥用（0.37）均统计学显著预测持续性 PTH 的存在（p<0.0001）。聚类分析显示 PTH 亚组与 ICHD 分类相当：Cluster 1 中有 140 例患者（76%为持续性 PTH），Cluster 2 中有 160 例患者（83%为急性 PTH）。在持续性 PTH 中发现了四个不同的聚类。
既往心理病史、偏头痛史、新的 PTH 相关合并症和药物滥用可预测持续性 PTH 的发生，以及与急性和持续性 PTH 相关的两个自然发生的 PTH 聚类。管理重点应放在这些表型上。
