Liam Davenport

June 22, 2016

SAN DIEGO — Individuals who have experienced a traumatic brain injury (TBI) have a high and persistent prevalence of headaches for at least 5 years afterward, with the majority of headaches migraine-like, the results of a new study indicate.

The researchers report that patients with TBI appear to be up to five times more likely to experience headaches than the general population, with the effect and severity of the headaches maintained during 5 years of follow-up.

"Headaches after [TBI] should not be written off," Sylvia Lucas, MD, PhD, clinical professor at the University of Washington Medical Center, Seattle, and lead author of the study, commented in a release. "This study sheds light on education needed among primary care providers and other practitioners caring for those suffering from [TBI]."

She added: "The frequency, intensity and impact on daily functioning should be recorded to better treat headaches. Suffering from intense headaches after an injury shouldn't be the only option."

Dr Lucas presented these findings here at the American Headache Society (AHS) 58th Annual Scientific Meeting.

Randolph W. Evans, MD, clinical professor, Baylor College of Medicine, Houston, Texas, who was not involved in the study, described it as "an important and unique large prospective trial of patients with moderate to severe TBI."

He told Medscape Medical News: "This group was previously believed to have less headaches than those with mild TBI. In addition, civilian posttraumatic headaches were believed to be mainly tension-type, whereas this study finds most have the migraine phenotype."

As little is known about the natural history or effect of posttraumatic headache, the researchers prospectively studied 316 individuals who were admitted to inpatient rehabilitation after primarily moderate to severe TBI.

They gathered data on the participants' prior headache history, as well as the prevalence, frequency, classification, pain rating, and effect of new or worse headaches compared with those before the TBI.

The individuals had an average age of 42 years, 72% were men, and 73% were white. The most common cause of TBI was a motor vehicle crash, which was experienced by 55% of participants.

The team found that the participants had a high prevalence of new or worse headaches that persisted over the course of the study, at 38% at baseline and 37% at 3 months, 33% at 6 months, 34% at 12 months, and 35% at 60 months post-TBI.

The average level of headache pain, on a 0 to 10 scale, was also consistently throughout the study, at between 5.5 at baseline and 5.7 at 60 months postinjury. Moreover, the participants had notable impairment, as measured on the Headache Impact Test (HIT)-6 questionnaire, at mean score of 57.1 at 3 months and 56.5 at 60 months.

At 3 months, 50% of participants had headache several times per week or daily, which decreased to 36% by 60 months. The most common form of headache was migraine or probable migraine, at 59% at 60 months.

Dr Lucas told Medscape Medical News that studies in the general population to estimate the background prevalence of headache are "difficult to do," as people often forget about their headaches or do not go to a physician.

Nevertheless, she said that moderate to severe, relatively disabling headaches are experienced by approximately 18% of women and 6% of men, with only slight variations between countries.

Dr Lucas pointed out that, as the typical profile of the participants in the current study was a civilian male of 41 years of age, "we're supposed to be in the 6% range, and here we are in the 38% range."

She said that it is not possible to say at this stage what is underlying the increased prevalence of headache post-TBI, "because we have a deplorable lack of basic science knowledge of what goes on in [TBIs]."

In other areas of medical research, it is possible to use an animal model, Dr Lucas explained, "but we cannot use an animal model for headache because you can't ask them." As a consequence, headache research relies on interviews or brain scans, which have "been helpful, but not completely," she said.

She added: "My own personal opinion is that there's going to be some overlap between the headache you get from [TBI] and the headache you get if you were born with the migraine gene, because sometimes when we ask folks to explain what their headaches are like, they are very similar."

Summarizing, Dr Lucas said: "I feel that our study is kind of step 1: Who gets it, what do they get, how long does it last?"

"Step 2 is going to be much more difficult, and that is: How can we treat these? We have no evidence-based medicines as of yet, so we're all treating these headaches by the seat of our pants.

"We're using the same drug for a migraine-like headache after a brain injury as we use for a migraine headache as a primary headache, so that's a tall order, but that's what people are trying to do now," she concluded.

No funding declared. The authors have disclosed no relevant financial relationships.

American Headache Society (AHS) 58th Annual Scientific Meeting: Abstract 157314. Presented June 9, 2016.

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