Pre-Injury headache and post-traumatic headache in patients with mild traumatic brain injury: neuropsychological, psychiatric, and post-concussion symptom outcomes

ABSTRACT

Primary Objective

Headache, both before and after injury, has been associated with worse outcome following mild traumatic brain injury (MTBI). This study examined whether three MTBI patient groups – no headache (reported no pre-/post-injury headache), pre-injury headache (reported pre-injury headache, nearly all of whom also reported post-injury headache), and post-traumatic headache only (denied pre-injury headache and reported post-injury headache) – differed in acute-to-subacute outcomes.

Research Design

Cross-sectional observational study.

Methods and Procedures

Patients within 21 days of a MTBI (n = 291) completed neuropsychological tests and questionnaires evaluating depression, anxiety, and post-concussion symptoms.

Main Outcomes and Results

Neuropsychological test performances did not differ between headache groups. Participants with pre-injury headache and participants with post-traumatic headache only reported greater change in self-reported physical and cognitive symptoms than participants with no headache. Participants with pre-injury headache reported worse post-injury anxiety symptoms than participants with post-traumatic headache only.

Conclusions

The pre-injury headache and post-traumatic headache only groups did not meaningfully differ in outcome within 21 days of MTBI, but they had worse physical and cognitive symptoms than participants with no headache. Future research should assess whether differences in outcome emerge further from injury and whether specific headache subtypes are differentially associated with outcome.

KEYWORDS:

• Brain concussion
• post-traumatic headache
• post-concussion syndrome
• depression
• anxiety
• neuropsychological tests

Acknowledgments

Dr. Iverson acknowledges unrestricted philanthropic support from the Heinz Family Foundation and the Spaulding Research Institute.

Disclosure statement

Grant Iverson, Ph.D. has been reimbursed by the government, professional scientific bodies, and commercial organizations for discussing or presenting research relating to mild TBI and sport-related concussion at meetings, scientific conferences, and symposiums. He has a clinical and consulting practice in forensic neuropsychology, including expert testimony, involving individuals who have sustained mild TBIs. He has received research funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.), and the National Football League. He serves as a scientific advisor for Sway Operations, LLC, Highmark, Inc., and NanoDx™. He acknowledges unrestricted philanthropic support from ImPACT Applications, Inc., the Mooney-Reed Charitable Foundation, Boston Bolts, and National Rugby League.

Additional information

Funding

This work was supported by the Ministry of Science and Technology in Taiwan [MOST 108-2410-H-004-087- and MOST 108-2918-I-004-0].