Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.
Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway.
J Headache Pain. 2024 Mar 25;25(1):44. doi: 10.1186/s10194-024-01751-0.
Headache is a prevalent and debilitating symptom following traumatic brain injury (TBI). Large-scale, prospective cohort studies are needed to establish long-term headache prevalence and associated factors after TBI. This study aimed to assess the frequency and severity of headache after TBI and determine whether sociodemographic factors, injury severity characteristics, and pre- and post-injury comorbidities predicted changes in headache frequency and severity during the first 12 months after injury.
A large patient sample from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) prospective observational cohort study was used. Patients were stratified based on their clinical care pathway: admitted to an emergency room (ER), a ward (ADM) or an intensive care unit (ICU) in the acute phase. Headache was assessed using a single item from the Rivermead Post-Concussion Symptoms Questionnaire measured at baseline, 3, 6 and 12 months after injury. Mixed-effect logistic regression analyses were applied to investigate changes in headache frequency and associated predictors.
A total of 2,291 patients responded to the headache item at baseline. At study enrolment, 59.3% of patients reported acute headache, with similar frequencies across all strata. Female patients and those aged up to 40 years reported a higher frequency of headache at baseline compared to males and older adults. The frequency of severe headache was highest in patients admitted to the ICU. The frequency of headache in the ER stratum decreased substantially from baseline to 3 months and remained from 3 to 6 months. Similar trajectory trends were observed in the ICU and ADM strata across 12 months. Younger age, more severe TBI, fatigue, neck pain and vision problems were among the predictors of more severe headache over time. More than 25% of patients experienced headache at 12 months after injury.
Headache is a common symptom after TBI, especially in female and younger patients. It typically decreases in the first 3 months before stabilising. However, more than a quarter of patients still experienced headache at 12 months after injury. Translational research is needed to advance the clinical decision-making process and improve targeted medical treatment for headache.
ClinicalTrials.gov NCT02210221.
头痛是创伤性脑损伤（TBI）后的一种常见且使人虚弱的症状。需要进行大规模的前瞻性队列研究，以确定 TBI 后长期头痛的患病率和相关因素。本研究旨在评估 TBI 后头痛的频率和严重程度，并确定社会人口统计学因素、损伤严重程度特征以及受伤前后的合并症是否可预测损伤后 12 个月内头痛频率和严重程度的变化。
本研究使用了来自欧洲颅脑外伤合作有效性研究（CENTER-TBI）前瞻性观察队列研究的大量患者样本。患者根据其临床护理途径进行分层：急诊室（ER）、病房（ADM）或重症监护病房（ICU）。使用 Rivermead 脑震荡后症状问卷中的一个单项评估头痛，该问卷在基线、受伤后 3、6 和 12 个月进行测量。应用混合效应逻辑回归分析来研究头痛频率的变化及其相关预测因素。
共有 2291 名患者在基线时回答了头痛项目。在研究入组时，59.3%的患者报告有急性头痛，所有分层的频率相似。与男性和老年人相比，女性患者和年龄在 40 岁以下的患者在基线时报告头痛的频率更高。在 ICU 入院的患者中，严重头痛的频率最高。在 ER 分层中，头痛的频率从基线到 3 个月显著下降，并从 3 个月持续到 6 个月。在 ICU 和 ADM 分层中，在 12 个月内观察到相似的趋势。随着时间的推移，年龄较小、TBI 更严重、疲劳、颈部疼痛和视力问题是头痛更严重的预测因素。超过 25%的患者在受伤后 12 个月仍有头痛。
头痛是 TBI 后的常见症状，尤其是在女性和年轻患者中。它通常在头 3 个月内减少，然后稳定。然而，超过四分之一的患者在受伤后 12 个月仍有头痛。需要转化研究来推进临床决策过程并改善针对头痛的靶向治疗。
ClinicalTrials.gov NCT02210221。
