Associations between traumatic brain injury history and future headache severity in Veterans: a longitudinal study

Publication date: Available online 5 May 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Pradeep Suri, Kelly Stolzmann, Katherine M. Iverson, Rhonda Williams, Mark Meterko, Kun Yan, Katelyn Gormley, Terri K. Pogoda
ObjectiveTo determine whether traumatic brain injury (TBI) history is associated with worse headache severity outcomes.DesignProspective cohort study.SettingDepartment of Veterans Affairs (VA) outpatient clinics.Participants2566 Veterans who completed a mail follow-up survey an average of 3 years after a comprehensive TBI evaluation (CTBIE).Main Outcome MeasuresThe 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.ResultsMean 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 (ß [SE]= 0.61[0.07], p<0.001), as compared to no TBI, but not in longitudinal analyses (ß [SE]= 0.09[0.07], p=0.20). Moderate/severe TBI was significantly associated with greater headache severity in both cross-sectional (ß [SE]= 0.66[0.09], p<0.001) and longitudinal analyses (ß [SE]= 0.18[0.09], p=0.04).ConclusionsHeadache 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. This study found no association 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.



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