Disability from posttraumatic headache is compounded by coexisting posttraumatic stress disorder

Louise S Roper, Peter Nightingale, Zhangjie Su, James L Mitchell, Antonio Belli, Alexandra J Sinclair, Louise S Roper, Peter Nightingale, Zhangjie Su, James L Mitchell, Antonio Belli, Alexandra J Sinclair

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; neurotrauma; traumatic brain injury.

Conflict of interest statement

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.

Figures

Figure 1
Figure 1
Diagram showing the selection of study patients. Abbreviations: HIT-6, Headache Impact Test version 6; PCL-C, PTSD Check List Civilian version; PTSD, posttraumatic stress disorder.
Figure 2
Figure 2
The number of patients with little, limited, substantial, and severe impact from PTH, as defined by their HIT-6 score. (A) Subcategorization by the number of patients with mild or moderate/severe TBI. (B) Subcategorization by the number of patients whose PCL-C scores indicate the presence/absence of PTSD symptoms. Abbreviations: PTH, posttraumatic headache; HIT-6, Headache Impact Test version 6; TBI, traumatic brain injury; PCL-C, PTSD Check List Civilian version; PTSD, posttraumatic stress disorder.
Figure 3
Figure 3
HIT-6 and PCL-C scores correlated significantly (rho=0.583, p<0.001). Abbreviations: HIT-6, Headache Impact Test version 6; PCL-C, PTSD Check List Civilian version; PTSD, posttraumatic stress disorder.

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