Natural History of Headache after Traumatic Brain Injury
Natural History of Headache after Traumatic Brain Injury
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DOI：
10.1089/neu.2011.1914
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发表时间：
2011-09-01
影响因子：
4.2
通讯作者：
Bell, Kathleen R.
中科院分区：
文献类型：
--
作者：
Hoffman, Jeanne M.;Lucas, Sylvia;Bell, Kathleen R.
头痛是创伤性脑损伤（TBI）后最常见的持续症状之一。然而，在一系列损伤严重程度的样本中，关于头痛的发生率和患病率的前瞻性纵向研究很少。我们试图描述TBI后第一年头痛的自然史，并确定既往头痛史、性别和TBI严重程度作为创伤后头痛风险因素的作用。2008年2月至2009年6月，在住院康复期间，入组了452例急性TBI住院康复服务连续患者。受试者在指定为TBI模型系统中心的7个急性康复中心入组。他们进行了前瞻性的评估，住院康复出院前的结构化访谈，并在受伤后3个月，6个月和12个月。这项自然史研究的结果表明，71%的参与者在受伤后的第一年内报告头痛。头痛的患病率在第一年仍然很高，超过41%的参与者在受伤后3个月，6个月和12个月报告头痛。受伤前有头痛史的人（p < 0.001）和女性（p < 0.01）更容易报告头痛。头痛的发生率与TBI的严重程度无关（p=0.67）。总的来说，头痛在TBI后的第一年很常见，与本研究中检查的损伤严重程度无关。使用国际头痛疾病分类标准要求在受伤后1周内头痛发作低估了创伤后头痛的发生率。更好地了解头痛的自然史，包括时间，类型和危险因素，应有助于设计治疗研究，以预防或减少头痛的慢性化及其对生活质量的破坏性影响。
Headache is one of the most common persisting symptoms after traumatic brain injury (TBI). Yet there is a paucity of prospective longitudinal studies of the incidence and prevalence of headache in a sample with a range of injury severity. We sought to describe the natural history of headache in the first year after TBI, and to determine the roles of prior history of headache, sex, and severity of TBI as risk factors for post-traumatic headache. A cohort of 452 acute, consecutive patients admitted to inpatient rehabilitation services with TBI were enrolled during their inpatient rehabilitation from February 2008 to June 2009. Subjects were enrolled across 7 acute rehabilitation centers designated as TBI Model Systems centers. They were prospectively assessed by structured interviews prior to inpatient rehabilitation discharge, and at 3, 6, and 12 months after injury. Results of this natural history study suggest that 71% of participants reported headache during the first year after injury. The prevalence of headache remained high over the first year, with more than 41% of participants reporting headache at 3, 6, and 12 months post-injury. Persons with a pre-injury history of headache (p < 0.001) and females (p < 0.01) were significantly more likely to report headache. The incidence of headache had no relation to TBI severity (p=0.67). Overall, headache is common in the first year after TBI, independent of the severity of injury range examined in this study. Use of the International Classification of Headache Disorders criteria requiring onset of headache within 1 week of injury underestimates rates of post-traumatic headache. Better understanding of the natural history of headache including timing, type, and risk factors should aid in the design of treatment studies to prevent or reduce the chronicity of headache and its disruptive effects on quality of life.