Disability from posttraumatic headache is compounded by coexisting posttraumatic stress disorder

Abstract

Background

Posttraumatic headache (PTH) occurs in up to 82% of patients with traumatic brain injury (TBI). Posttraumatic stress disorder (PTSD) occurs in 39% of those with PTH. This study evaluates whether PTSD affects PTH disability.

Methods

Eighty-six patients with TBI were prospectively evaluated in a secondary care trauma center. Headache disability was assessed using the Headache Impact Test version 6 and signs indicative of PTSD using the PTSD Check List Civilian version.

Results

Increased PTSD-type symptoms were significantly associated with increased headache disability (p<0.001), as were employment status and loss of consciousness (p=0.049 and 0.016, respectively). Age was negatively correlated with headache disability (Spearman’s correlation rho=0.361, p=0.001).

Conclusion

Increased severity of PTSD-type symptoms is significantly associated with increased headache disability in patients with chronic PTH. Managing PTSD symptoms in patients with chronic PTH may facilitate headache management.

Keywords:

• chronic headache
• traumatic brain injury
• neurotrauma

Acknowledgments

The authors thank Ahmed Al-Jabir for providing technical support.

Author contributions

Louise Roper contributed to data cleaning, data coding and analysis, and writing of the article. Peter Nightingale contributed to statistical analysis. Zhangjie Su contributed to study design, data collection, and review of the article. James Mitchell contributed to review and writing of the article. Antonio Belli contributed to study design and data collection. Alexandra J Sinclair contributed to writing of the article. All authors contributed toward data analysis, drafting and critically revising the paper and agree to be accountable for all aspects of the work.

Disclosure

Dr Alexandra J Sinclair was financially supported by an NIHR Clinician Scientist Fellowship (NIHR-CS-011-028) and by the Medical Research Council, UK (MR/K015184/1). Professor Antonio Belli and Dr Zhangjie Su were financially supported by the National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health. The authors report no other conflicts of interest in this work.