Chronic Daily Headache in U.S. Soldiers After Concussion
Chronic Daily Headache in U.S. Soldiers After Concussion
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DOI：
10.1111/j.1526-4610.2012.02112.x
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发表时间：
2012-05-01
期刊：
影响因子：
5
通讯作者：
Erickson, Jay C.
中科院分区：
文献类型：
--
作者：
Theeler, Brett J.;Flynn, Frederick G.;Erickson, Jay C.
目的：确定美国士兵在部署相关脑震荡后慢性日常头痛 (CDH) 的患病率、特征和相关因素。方法：对 978 名从伊拉克或阿富汗返回后部署相关脑震荡筛查呈阳性的美国士兵进行了一项横断面、基于问卷调查的研究。所有士兵都在马迪根脑外伤项目中接受了临床评估，包括病史、体格检查、13 项自填头痛问卷以及一系列认知和心理评估。将患有 CDH 的士兵（定义为过去 3 个月中每月发生 15 天或以上头痛）与每月发生少于 15 天的阵发性头痛的士兵进行比较。 结果：978 名有部署相关脑震荡病史的士兵中，有 196 名 (20%) 符合 CDH 标准，其中 761 名 (78%) 患有阵发性头痛。患有 CDH 的士兵每月头痛天数中位数为 27 天，46/196 (23%) 的士兵报告每天都会头痛。 196 名患有 CDH 的士兵中，有 177 名 (55%) 在头部外伤后 1 周内出现头痛，因此符合创伤后头痛 (PTHA) 的时间标准，而患有阵发性头痛的士兵为 253/761 (33%)。 196 名患有 CDH 的士兵中，有 97 名 (49%) 在过去 3 个月内每月有 15 天或以上使用流产药物来治疗头痛。 196 名患有 CDH 的士兵中，有 130 名 (66%) 的头痛符合偏头痛的标准，而患有阵发性头痛的士兵的这一比例为 49%。患有和不患有 CDH 的士兵之间，脑震荡、爆炸暴露和脑震荡伴意识丧失的次数没有显着差异。有和没有 CDH 的士兵的认知表现也相似。与患有阵发性头痛的士兵相比，患有CDH的士兵在创伤后应激障碍（PTSD）检查表上的平均得分明显更高。 41% 患有 CDH 的士兵的 PTSD 筛查结果呈阳性，而患有阵发性头痛的士兵只有 18%。结论。在经历与部署相关的脑震荡后返回的美国士兵中，CDH 的患病率是 20%，比一般美国人群高 4 至 5 倍。脑震荡后的 CDH 通常类似于慢性偏头痛，并与脑震荡后第一周内头痛的发作有关。与阵发性头痛相比，脑震荡的机制和数量与 CDH 没有特定的相关性。相比之下，PTSD 症状与 CDH 密切相关，表明创伤性应激可能是头痛慢性化的重要介质。这些发现证明了未来研究预防和治疗军人脑震荡损伤后 CDH 的策略是合理的。
Objective.-To determine the prevalence and characteristics of, and factors associated with, chronic daily headache (CDH) in U.S. soldiers after a deployment-related concussion.Methods.-A cross-sectional, questionnaire-based study was conducted with a cohort of 978 U.S. soldiers who screened positive for a deployment-related concussion upon returning from Iraq or Afghanistan. All soldiers underwent a clinical evaluation at the Madigan Traumatic Brain Injury Program that included a history, physical examination, 13-item self-administered headache questionnaire, and a battery of cognitive and psychological assessments. Soldiers with CDH, defined as headaches occurring on 15 or more days per month for the previous 3 months, were compared to soldiers with episodic headaches occurring less than 15 days per month.Results.-One hundred ninety-six of 978 soldiers (20%) with a history of deployment-related concussion met criteria for CDH and 761 (78%) had episodic headache. Soldiers with CDH had a median of 27 headache days per month, and 46/196 (23%) reported headaches occurring every day. One hundred seven out of 196 (55%) soldiers with CDH had onset of headaches within 1 week of head trauma and thereby met the time criterion for posttraumatic headache (PTHA) compared to 253/761 (33%) soldiers with episodic headache. Ninety-seven out of 196 (49%) soldiers with CDH used abortive medications to treat headache on 15 or more days per month for the previous 3 months. One hundred thirty out of 196 (66%) soldiers with CDH had headaches meeting criteria for migraine compared to 49% of soldiers with episodic headache. The number of concussions, blast exposures, and concussions with loss of consciousness was not significantly different between soldiers with and without CDH. Cognitive performance was also similar for soldiers with and without CDH. Soldiers with CDH had significantly higher average scores on the posttraumatic stress disorder (PTSD) checklist compared to soldiers with episodic headaches. Forty-one percent of soldiers with CDH screened positive for PTSD compared to only 18% of soldiers with episodic headache.Conclusions.-The prevalence of CDH in returning U.S. soldiers after a deployment-related concussion is 20%, or 4- to 5-fold higher than that seen in the general U.S. population.CDH following a concussion usually resembles chronic migraine and is associated with onset of headaches within the first week after concussion. The mechanism and number of concussions are not specifically associated with CDH as compared to episodic headache. In contrast, PTSD symptoms are strongly associated with CDH, suggesting that traumatic stress may be an important mediator of headache chronification. These findings justify future studies examining strategies to prevent and treat CDH in military service members following a concussive injury.