Headache After Traumatic Brain Injury: A National Survey of Clinical Practices and Treatment Approaches
Headache After Traumatic Brain Injury: A National Survey of Clinical Practices and Treatment Approaches
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DOI：
10.1016/j.pmrj.2014.06.016
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发表时间：
2015-01-01
期刊：
影响因子：
2.1
通讯作者：
Dikmen, Sureyya
中科院分区：
文献类型：
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作者：
Brown, Allen W.;Watanabe, Thomas K.;Dikmen, Sureyya
背景：创伤性脑损伤 (TBI) 后头痛的个体在不同的临床地点接受经过多个专业培训的医生的护理。目的：了解治疗 TBI 后头痛的临床医生当前的实践模式和对治疗问题的看法。设计：使用作者开发的 20 项调查问卷对当前临床实践进行全国调查。参与者：调查受访者是美国物理医学与康复学会中枢神经系统委员会名单调查的成员 (N = 1782）和美国头痛协会会员（N = 1260）。方法：该调查以电子方式发送给潜在参与者，随后每两周进行两次提醒。该调查询问了医生的临床情况；他们使用头痛分类系统、头痛日记、检查表和诊断程序；规定的药物和非药物治疗；结果：收到了 193 名受访者的完整调查。人们普遍报告了标准化分类系统和检查表的使用。受访者使用非药物和药物治疗方法的频率相似，但感知成功率较低。据报道，与头痛相关的新的睡眠和情绪障碍的频率很高。当实践环境之间出现反应差异时，它们反映了神经科和专业头痛诊所对头痛诊断、分类和药物治疗的关注，而 TBI 专业和普通康复临床医生更常见的非药物治疗方法。结论：TBI 后头痛的治疗策略在普通和专业临床实践中存在很大差异。这表明需要进行更多研究，以增加已建立的头痛分类的使用和标准化管理方法的开发，以便所有护理 TBI 后患者的从业人员能够提供一致有效的护理。
Background: Individuals with headache after traumatic brain injury (TBI) receive care in a wide variety of clinical locations by physicians trained in multiple specialties.Objective: To understand current practice patterns and perceptions of treatment issues among clinicians managing headache after TBI.Design: National survey of current clinical practice using a 20-item questionnaire developed by the authors.Participants: Survey respondents were members of the Central Nervous System Council list survey of the American Academy of Physical Medicine and Rehabilitation (N = 1782) and the American Headache Society membership (N = 1260).Methods: The survey was sent electronically to potential participants and was followed by 2 biweekly reminders. The survey queried the physicians' clinical setting; their use of headache classification systems, headache diaries, checklists, and diagnostic procedures; the pharmacologic and nonpharmacologic treatments prescribed; and headache chronicity and associated symptoms and disorders among their patients with TBI.Results: Completed surveys were received from 193 respondents. The use of standardized classification systems and checklists was commonly reported. Respondents used nonpharmacologic and pharmacologic treatment approaches with similar frequency and modest perceived success rates. A high frequency of headache-associated new sleep and mood disorders was reported. When response differences occurred between practice settings, they reflected a focus on headache diagnosis, classification, and pharmacologic treatment among neurology and specialty headache clinics, whereas a nonpharmacologic approach to management among TBI specialty and general rehabilitation clinicians was more commonly reported.Conclusion: Management strategies for treating headache after TBI vary widely among general and specialty clinical practices. This suggests that additional research is needed that would lead to an increase in the use of established headache classification and the development of standardized management approaches so that all practitioners who care for patients after TBI can provide consistent effective care.