Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland (Mr Flynn, Ms Lo, and Drs Shahim and Chan); Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland (Messrs Moore and van der Merwe, Ms Moses, and Drs Shahim and Chan); and The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland (Messrs Moore and van der Merwe and Ms Moses).
J Head Trauma Rehabil. 2023;38(2):E109-E117. doi: 10.1097/HTR.0000000000000790. Epub 2022 May 26.
To describe headache characteristics over time in patients with traumatic brain injury (TBI).
Patients enrolled and followed at the National Institutes of Health Clinical Center between 2011 and 2020.
There were 147 patients with TBI, with 74 mild TBI (mTBI), 49 moderate (modTBI), 24 severe (sTBI), and 20 individuals without brain injury (IWBIs).
Regular surveys of headache characteristics in patients with TBI were conducted. Patients were enrolled as early as 30 days post-injury and followed up to 5 years, for 419 total visits and 80 patients with multiple return visits.
Surveys of headache characteristics, including headache severity, were measured on a 0- to 10-point Likert scale and headache frequency quantified as headaches per month. Patients with migraine-type headaches ( n = 39) were identified by a clinician-administered tool. Functional outcomes were measured using the Glasgow Outcome Scale-Extended (GOS-E) and quality of life by the Satisfaction with Life Scale (SWLS) and the 36-item Short Form Survey (SF-36).
At their initial visit, patients with TBI had more severe and frequent headaches than IWBIs (median 5 vs 2.5, P < .001; median 2 vs 0.2, P < .001), as did patients with mTBI compared with modTBI/sTBI (all P ≤ .01). Migraines were associated with lower SWLS and SF-36 scores. Migraines and young age were associated with higher headache severity and frequency across time points. Longitudinally, time post-injury correlated with improvement in headache severity and frequency without differences by injury severity. However, time post-injury did not correlate with improvement in headache characteristics in a patient subgroup with moderate/severe headaches.
Our findings suggest that patients with mild, moderate, or severe TBI see improvement in headaches over time. However, patients should be counseled that improvement is modest and seen more in patients with milder headache symptoms. Patients with migraine headaches in particular are at risk for worse headache characteristics with greater impact on quality of life.
描述创伤性脑损伤（TBI）患者随时间推移的头痛特征。
2011 年至 2020 年间，在国立卫生研究院临床中心招募并随访了患者。
共有 147 例 TBI 患者，其中 74 例为轻度 TBI（mTBI），49 例为中度（modTBI），24 例为重度（sTBI），20 例为无脑损伤（IWBIs）。
对 TBI 患者的头痛特征进行定期调查。患者最早在损伤后 30 天入组，并随访 5 年，共进行了 419 次就诊，80 例患者多次就诊。
采用 0-10 分的 Likert 量表测量头痛特征，包括头痛严重程度，并用每月头痛次数量化头痛频率。通过临床医生管理的工具识别偏头痛型头痛患者（n=39）。使用格拉斯哥结局量表扩展版（GOS-E）测量功能结局，使用生活满意度量表（SWLS）和 36 项简短健康调查量表（SF-36）测量生活质量。
在初次就诊时，TBI 患者的头痛严重程度和频率均高于 IWBIs（中位数 5 分比 2.5 分，P<0.001；中位数 2 分比 0.2 分，P<0.001），mTBI 患者也比 modTBI/sTBI 患者严重（均 P≤0.01）。偏头痛与 SWLS 和 SF-36 评分较低相关。偏头痛和年龄较小与随时间推移的头痛严重程度和频率增加相关。纵向研究显示，损伤后时间与头痛严重程度和频率的改善相关，而与损伤严重程度无关。然而，在中度/重度头痛患者亚组中，损伤后时间与头痛特征的改善无关。
我们的研究结果表明，轻度、中度或重度 TBI 患者的头痛随时间推移会有所改善。然而，应该告知患者，改善幅度较小，且在轻度头痛症状患者中更为明显。有偏头痛的患者头痛特征恶化的风险更高，对生活质量的影响更大。
