Associations Between Traumatic Brain Injury History and Future Headache Severity in Veterans: A Longitudinal Study

Arch Phys Med Rehabil. 2017 Nov;98(11):2118-2125.e1. doi: 10.1016/j.apmr.2017.04.008. Epub 2017 May 5.

Abstract

Objective: To determine whether traumatic brain injury (TBI) history is associated with worse headache severity outcomes.

Design: Prospective cohort study.

Setting: Department of Veterans Affairs (VA) outpatient clinics.

Participants: Veterans (N=2566) who completed a mail follow-up survey an average of 3 years after a comprehensive TBI evaluation (CTBIE).

Interventions: Not applicable.

Main outcome measures: The presence or absence of TBI, and TBI severity were evaluated by a trained clinician and classified according to VA/Department of Defense clinical practice guidelines. Headache severity was evaluated at both the baseline CTBIE assessment and 3-year follow-up using a 5-level headache score ranging from 0 ("none") to 4 ("very severe") based on headache-associated activity interference in the past 30 days. We examined associations of mild and moderate/severe TBI history, as compared to no TBI history, with headache severity in cross-sectional and longitudinal analyses, with and without adjustment for potential confounders.

Results: Mean headache severity scores were 2.4 at baseline and 2.3 at 3-year follow-up. Mild TBI was associated with greater headache severity in multivariate-adjusted cross-sectional analyses (β [SE]=.61 [.07], P<.001), as compared with no TBI, but not in longitudinal analyses (β [SE]=.09 [.07], P=.20). Moderate/severe TBI was significantly associated with greater headache severity in both cross-sectional (β [SE]=.66 [.09], P<.001) and longitudinal analyses (β [SE]=.18 [.09], P=.04).

Conclusions: Headache outcomes are poor in veterans who receive VA TBI evaluations, irrespective of past TBI exposure, but significantly worse in those with a history of moderate/severe TBI. No association was found between mild TBI and future headache severity in veterans. Veterans with headache presenting for TBI evaluations, and particularly those with moderate/severe TBI, may benefit from further evaluation and treatment of headache.

Keywords: Brain concussion; Brain injuries, traumatic; Headache; Migraine disorders; Post-concussion syndrome; Tension-type headache.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Afghan Campaign 2001-
  • Age Factors
  • Aged
  • Blast Injuries / epidemiology
  • Brain Injuries, Traumatic / complications*
  • Brain Injuries, Traumatic / physiopathology*
  • Cross-Sectional Studies
  • Depression / epidemiology
  • Female
  • Headache / etiology*
  • Headache / physiopathology*
  • Humans
  • Iraq War, 2003-2011
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Pain / epidemiology
  • Prospective Studies
  • Severity of Illness Index
  • Sex Factors
  • Socioeconomic Factors
  • Stress Disorders, Post-Traumatic / epidemiology
  • Substance-Related Disorders / epidemiology
  • United States
  • United States Department of Veterans Affairs
  • Veterans / statistics & numerical data*
  • Young Adult