Occurrence of two or more head injuries doubles the risk of persistent severe headache, suggests a new study reported in the journal Neurology.¹ Such individuals are also six times more likely to experience migraine-like features.

This cross-sectional study retrospectively analysed the medical records of 594 veterans who underwent evaluation for traumatic brain injury (TBI) between 2011 and 2021 with the aim to find the association, if any, between the TBI and headache and to also characterize the headache across all levels of severity of the injury categorized as sub concussive exposure, mild, moderate and severe TBI. No study participant however had had severe head injury.

Compared to veterans with subconcussive head impact, those who had mild TBI were at nearly twice the higher risk of increased headache severity with adjusted odds ratio of 1.72. Those with moderate TBI were nearly 4 times at risk of severe headaches with aOR of 3.89.

Headache in veterans with two or more head injuries was more likely to be severe (aOR 2.47) and was six times more associated with migraine-like features (aOR 5.95).

Veterans with altered consciousness and those who experienced amnesia for more than 30 minutes after the injury had more severe headaches with aOR of 3.37 and 5.40, respectively. Longer interval between the occurrence of the last TBI and its evaluation was associated with more severe headache (aOR 1.09) and migraine-like features (aOR 1.27) such as throbbing, photophobia, nausea, vomiting. Veterans who used helmets showed 58% decrease in less severe headache (aOR 0.42); they also had 55% reduction in probability of features that usually accompany a migraine headache (aOR 0.45). A little over half of the participants also were diagnosed with post-traumatic stress disorder (PTSD). Veterans who experienced a combination of primary and tertiary blast effects also reported more severe headaches (aOR 2.56) versus those who experienced only one type of blast injury or did not suffer any blast injury.

These observations indicate that the odds of headache increased with the severity of the TBI. Veterans who had sustained multiple head injuries were more likely to suffer persistent headaches. Post traumatic amnesia and altered or loss of consciousness were the other risk factors. This characterization of headache in persons with a history of TBI may help the clinician to identify patients at risk for persistent post-traumatic headache enabling earlier and individualized interventions. A history of TBI must be elicited when managing headache particularly among the veterans and multidisciplinary care instituted regardless of a positive or negative history of TBI.

Reference

1. Colt Coffman, et al. Relationship between headache characteristics and a remote history of TBI in veterans: A 10-year retrospective chart review. Neurology. 2022 Jul 12;99(2):e187-e198. doi: 10.1212/WNL.0000000000200518.