Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
South Texas Veterans Health Care System, San Antonio, TX, USA.
NeuroRehabilitation. 2024;55(3):303-317. doi: 10.3233/NRE-230277.
Chronic headache after traumatic brain injury (TBI) is a common, yet disabling, disorder whose diverse clinical characteristics and treatment needs remain poorly defined.
To examine diagnostic coding patterns and cost among military Veterans with comorbid chronic headache and TBI.
We identified 141,125 post-9/11 era Veterans who served between 2001 and 2019 with a headache disorder diagnosed after TBI. We first identified patterns of Complex Headache Combinations (CHC) and then compared the patterns of healthcare costs in 2022-dollar values in the three years following the TBI diagnosis.
Veterans had diverse individual headache and CHC diagnoses with uniformly high cost of care. Post-whiplash and post-TBI CHCs were common and consistently associated with higher costs after TBI than those with other types of headache and CHCs. Post-TBI migraine had the highest unadjusted mean inpatient ($27,698), outpatient ($61,417), and pharmacy ($4,231) costs, which persisted even after adjustment for confounders including demographic, military, and clinical characteristics.
Headache diagnoses after TBI, particularly those diagnosed with post-traumatic headache, are complex, and associated with dual high cost and care burdens. More research is needed to examine whether this higher expenditure reflects more intensive treatment and better outcomes or refractory headache with worse outcomes.
创伤性脑损伤（TBI）后慢性头痛是一种常见但致残的疾病，其临床表现多样，治疗需求仍未得到明确界定。
研究患有慢性头痛和 TBI 的退伍军人的诊断编码模式和成本。
我们确定了 141125 名 9/11 后时代的退伍军人，他们在 2001 年至 2019 年期间服役，在 TBI 后被诊断出患有头痛障碍。我们首先确定了复杂头痛组合（CHC）的模式，然后比较了 TBI 诊断后三年中 2022 年美元价值的医疗保健费用模式。
退伍军人的头痛和 CHC 诊断各不相同，护理费用均很高。创伤后颈痛和创伤后 CHC 很常见，并且与 TBI 后比其他类型的头痛和 CHC 更相关的更高成本相关。创伤后偏头痛的未调整平均住院费用（$27698）、门诊费用（$61417）和药房费用（$4231）最高，即使在调整了人口统计学、军事和临床特征等混杂因素后也是如此。
TBI 后的头痛诊断，特别是创伤后头痛的诊断，是复杂的，与双重高成本和护理负担相关。需要进一步研究以检查这种更高的支出是否反映了更密集的治疗和更好的结果，或者是难治性头痛和更差的结果。
