Headache after moderate and severe traumatic brain injury: A longitudinal analysis

Objectives: To measure longitudinally headache (HA) after moderate and severe traumatic brain injury (TBI) and to examine potential association with demographic, injury, and psychologic factors. Design: Cohort study. Setting: Four Veterans Administration rehabilitation facilities (Minneapolis, Palo Alto, Richmond, Tampa) within the Defense and Veterans Brain Injury Center. Participants: Consecutive patients (military or veteran beneficiaries) with moderate or severe TBI (N = 109) who during acute rehabilitation consented to data collection and who completed 6- and 12-month follow-up evaluations. Interventions: Not applicable. Main Outcome Measures: HA frequency, location, type, and incapacitation levels measured during prospective neurologic assessments. Results: Nearly 38% (41/109) of patients had acute post-traumatic headache (PTHA) symptoms; most often in a frontal location (20/41), most often of daily frequency (31/41), and showing no relation to injury severity, emotional, or demographic variables. Postacutely, PTHA symptom severity declined within the group. Better individual improvement was associated with less anxiety and depression at 6-month follow-up. Almost all subjects (21/22) with PTHA symptoms that persisted into the 6-month follow-up period reported symptoms again at 12-month follow-up. Conclusions: PTHA severity in this sample of persons with moderate and severe TBI showed a pattern of improvement that leveled off by 6 months posthospitalization.