1685Uniformed Services University, Bethesda, MD, USA.
Vector Psychometric Group, LLC, Chapel Hill, NC, USA.
Cephalalgia. 2021 Apr;41(5):582-592. doi: 10.1177/0333102420974352. Epub 2020 Nov 27.
Post-traumatic headaches are a common sequela of mild traumatic brain injury (concussion). It is unclear whether or how these headaches differ phenotypically from primary headaches.
Determine whether there is an overarching unobserved latent trait that drives the expression of observed features of post-traumatic headache and other headaches.
Data from this analysis come from the Warrior Strong Cohort Study conducted from 2010 through 2015. Approximately 25,000 soldiers were screened for concussion history at routine post-deployment health assessments. A random sample was invited to participate, enrolling 1567. Twelve observed headache phenotypic features were used to measure "headache complexity", the latent trait of clinical interest, using single factor confirmatory factor analysis. We compared headache complexity between groups and determined whether headache complexity predicted accessing medical care for headache.
Of 1094 soldiers with headaches, 198 were classified as having post-traumatic headache. These headaches were compared to those in the other soldiers (647 without concussion history and 249 with concussion history). Soldiers with post-traumatic headache had greater endorsement of all 12 headache features compared to the soldiers with non-concussive headaches. The confirmatory factor analysis showed good model fit (χ (51) = 95.59, = 0.0002, RMSEA = 0.03, comparative fit index = 0.99, and Tucker-Lewis index = 0.99), providing empirical support for the headache complexity construct. Soldier groups differed in their mean headache complexity level ( < 0.001) such that post-traumatic headache soldiers had greater headache complexity compared to non-concussed soldiers (standardized mean difference = 0.91, 95% confidence interval: 0.72-1.09, < 0.001 and to concussed soldiers with coincidental headaches standardized mean difference = 0.75, 95% confidence interval: 0.53-0.96, < 0.001). Increasing headache complexity predicted medical encounters for headache (odds ratio = 1.87, 95% confidence interval: 1.49-2.35, < 0.001) and migraine (odds ratio = 3.74, 95% confidence interval: 2.33-5.98, < 0.001) during the year following deployment. The current study provided support for a single latent trait, characterized by observed headache symptoms, that differentiates between concussive and non-concussive headaches and predicts use of medical care for headache. The single trait confirmatory factor analysis suggests that post-traumatic headaches differ from non-concussive headaches by severity more than kind, based on the symptoms assessed.ClinicalTrials.gov identifier NCT01847040.
创伤后头痛是轻度创伤性脑损伤（脑震荡）的常见后遗症。目前尚不清楚这些头痛在表型上是否存在差异，以及如何存在差异。
确定是否存在一种潜在的、未被观察到的特征，驱动创伤后头痛和其他头痛的观察特征的表达。
本分析的数据来自于 2010 年至 2015 年进行的 Warrior Strong 队列研究。约有 25000 名士兵在常规部署后健康评估中接受了脑震荡史的筛查。邀请了一个随机样本参加，共纳入了 1567 人。使用单因素验证性因子分析，使用 12 个观察到的头痛表型特征来测量“头痛复杂性”，这是一个临床感兴趣的潜在特征。我们比较了不同组之间的头痛复杂性，并确定头痛复杂性是否预测了头痛的医疗护理。
在 1094 名患有头痛的士兵中，有 198 人被归类为患有创伤后头痛。与其他士兵（647 名无脑震荡史和 249 名有脑震荡史）相比，这些头痛具有更大的头痛特征。与非脑震荡性头痛的士兵相比，创伤后头痛的士兵对所有 12 个头痛特征的认可程度更高。验证性因子分析显示出良好的模型拟合（χ（51）= 95.59，p = 0.0002，RMSEA = 0.03，比较拟合指数 = 0.99，Tucker-Lewis 指数 = 0.99），为头痛复杂性结构提供了经验支持。不同的士兵组在他们的平均头痛复杂性水平上存在差异（p < 0.001），即创伤后头痛的士兵与非脑震荡的士兵相比，头痛复杂性更高（标准化平均差异= 0.91，95%置信区间：0.72-1.09，p < 0.001），与伴有偶发性头痛的脑震荡士兵相比，头痛复杂性更高（标准化平均差异= 0.75，95%置信区间：0.53-0.96，p < 0.001）。头痛复杂性的增加预测了头痛（优势比= 1.87，95%置信区间：1.49-2.35，p < 0.001）和偏头痛（优势比= 3.74，95%置信区间：2.33-5.98，p < 0.001）在部署后的一年内接受医疗护理。本研究支持了一个单一的潜在特征，其特征是观察到的头痛症状，可以区分脑震荡性和非脑震荡性头痛，并预测头痛的医疗护理使用。单特质验证性因子分析表明，创伤后头痛与非脑震荡性头痛的区别主要在于严重程度，而不是类型，这是基于评估的症状。临床Trials.gov 标识符 NCT01847040。
