Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA.
Headache. 2021 Oct;61(9):1334-1341. doi: 10.1111/head.14210. Epub 2021 Sep 27.
To characterize the relationship between head trauma types (blast injury, blunt injury, combined blast+blunt injury) with subsequent headache presentations and functioning.
Posttraumatic headaches (PTHs), the most common sequelae of traumatic brain injury (TBI), are painful and disabling. More than 400,000 veterans report having experienced a TBI, and understanding the predictors of PTHs may guide treatment developments.
This study used a nested-cohort design analyzing baseline data from a randomized clinical trial of cognitive behavioral therapy for PTH (N = 190). Participants had PTH (from blast and/or blunt head trauma) and symptoms of posttraumatic stress disorder (PTSD). The Structured Diagnostic Interview for Headache-Revised and Ohio State University Traumatic Brain Injury Identification Method were used to phenotype headaches and head injury histories, respectively.
Individuals with persistent PTHs after a combined blast and blunt head trauma were more likely (OR =3.45; 95% CI [1.41, 8.4]) to experience chronic (vs. episodic) PTHs compared with the blunt trauma only group (23/33, 70% vs. 26/65, 40%, respectively); and they were more likely (OR =2.51; 95% CI [1.07, 5.9]) to experience chronic PTH compared with the blast trauma only group (44/92, 48%). There were no differences between head injury type on headache-related disability, depression symptoms, or severity of PTSD symptoms.
The combination of blast and blunt injuries was associated with headache chronicity, but not headache disability. Considering the refractory nature of chronic headaches, the potential added and synergistic effects of distinct head injuries warrant further study.
描述头部创伤类型（爆炸伤、钝器伤、爆炸+钝器伤混合）与随后的头痛表现和功能之间的关系。
创伤后头痛（PTH）是创伤性脑损伤（TBI）最常见的后遗症，疼痛且使人丧失能力。超过 40 万退伍军人报告曾经历过 TBI，了解 PTH 的预测因素可能有助于指导治疗方法的发展。
本研究使用嵌套队列设计，分析了认知行为疗法治疗 PTH 的随机临床试验的基线数据（N=190）。参与者患有 PTH（来自爆炸和/或钝器头部创伤）和创伤后应激障碍（PTSD）症状。使用修订后的头痛结构诊断访谈和俄亥俄州立大学创伤性脑损伤识别方法分别对头痛和头部创伤史进行表型分析。
经历过爆炸和钝器混合头部创伤后持续存在 PTH 的个体更有可能（OR=3.45；95%CI[1.41,8.4]）经历慢性（与发作性相比）PTH，与单纯钝器创伤组相比（分别为 23/33，70%与 26/65，40%）；与单纯爆炸创伤组相比（OR=2.51；95%CI[1.07,5.9]），他们更有可能经历慢性 PTH（分别为 44/92，48%与 92/92，48%）。头部创伤类型与头痛相关残疾、抑郁症状或 PTSD 症状严重程度之间无差异。
爆炸和钝器伤的组合与头痛的慢性有关，但与头痛残疾无关。鉴于慢性头痛的难治性，不同头部损伤的潜在附加和协同作用值得进一步研究。
