McGeary Donald D, Resick Patricia A, Penzien Donald B, Eapen Blessen C, Jaramillo Carlos, McGeary Cindy A, Nabity Paul S, Peterson Alan L, Young-McCaughan Stacey, Keane Terence M, Reed David, Moring John, Sico Jason J, Pangarkar Sanjog S, Houle Timothy T
Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio, TX, USA.
Department of Rehabilitation Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
Cephalalgia. 2020 Oct;40(11):1155-1167. doi: 10.1177/0333102420953109. Epub 2020 Aug 31.
Posttraumatic headache is difficult to define and there is debate about the specificity of the 7-day headache onset criterion in the current definition. There is limited evidence available to guide decision making about this criterion.
A nested cohort study of 193 treatment-seeking veterans who met criteria for persistent headache attributed to mild traumatic injury to the head, including some veterans with delayed headache onset up to 90 days post-injury, was undertaken. Survival analysis examined the proportion of participants reporting headache over time and differences in these proportions based on sex, headache phenotype, and mechanism of injury.
127 participants (66%; 95% CI: 59-72%) reported headache onset within 7 days of head injury and 65 (34%) reported headache onset between 8 days and 3 months after head injury. Fourteen percent of participants reported pre-existing migraine before head injury, and there was no difference in the proportion of veterans with pre-existing migraine based on headache onset. Headache onset times were not associated with sex, headache phenotype, or mechanism of injury. There were no significant differences in proportion of veterans with headache onset within 7 days of head injury based on headache phenotype (70% migraine onset within 7 days, 70% tension-type headache within 7 days, 56% cluster headache within 7 days; ≥ .364). Similar findings were observed for head injury (64% blast, 60% blunt; = .973). There were no significant differences observed between headache onset groups for psychiatric symptoms (Posttraumatic Stress Disorder Checklist for = 1.3, 95% CI = -27.5, 30.1; Patient Health Questionnaire-9 Item = 3.5, 95% CI = -6.3, 3.7; Generalized Anxiety Disorder Screener = 6.5, 95% CI = -2.7, 15.6).
Although most of the sample reported headache onset within 7 days of head injury, one-third experienced an onset outside of the diagnostic range. Additionally, veterans with headache onset within 7 days of head injury were not meaningfully different from those with later onset based on sex, headache phenotype, or mechanism of head injury. The ICHD-3 diagnostic criteria for 7-day headache onset should be expanded to 3 months.
CLINICALTRIALS.GOV IDENTIFIER: NCT02419131.
创伤后头痛难以定义，当前定义中关于7日头痛发作标准的特异性存在争议。关于该标准的决策，可用证据有限。
对193名寻求治疗的退伍军人进行了一项巢式队列研究，这些退伍军人符合因轻度头部创伤导致持续性头痛的标准，其中一些退伍军人头痛发作延迟至受伤后90天。生存分析检查了随时间报告头痛的参与者比例，以及基于性别、头痛表型和损伤机制的这些比例差异。
127名参与者（66%；95%置信区间：59 - 72%）报告在头部受伤后7天内出现头痛，65名（34%）报告在头部受伤后8天至3个月内出现头痛。14%的参与者报告在头部受伤前就有偏头痛，基于头痛发作情况，有偏头痛病史的退伍军人比例没有差异。头痛发作时间与性别、头痛表型或损伤机制无关。基于头痛表型，在头部受伤后7天内出现头痛的退伍军人比例没有显著差异（7天内偏头痛发作70%，紧张型头痛70%，丛集性头痛56%；≥.364）。头部损伤类型方面也有类似发现（爆炸伤64%，钝器伤60%；= 0.973）。头痛发作组之间在精神症状方面没有显著差异（创伤后应激障碍检查表评分为1.3，95%置信区间 = -27.5，30.1；患者健康问卷 - 9项评分为3.5，95%置信区间 = -6.3，3.7；广泛性焦虑障碍筛查评分为6.5，95%置信区间 = -2.7，15.6）。
虽然大多数样本报告在头部受伤后7天内出现头痛，但三分之一的人发作时间超出了诊断范围。此外，基于性别、头痛表型或头部损伤机制，在头部受伤后7天内出现头痛的退伍军人与发作较晚的退伍军人没有显著差异。国际头痛疾病分类第三版（ICHD - 3）中7日头痛发作诊断标准应扩展至3个月。
NCT02419131
