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What Are the Predictors for and Psychosocial Correlates of Chronic Headache After Moderate to Severe Traumatic Brain
William C Walker1, Robert A Perera, Flora M Hammond
1Departments of Physical Medicine and Rehabilitation (Dr Walker and Ms Abbasi) and Biostatistics (Dr Perera), School of Medicine, Virginia Commonwealth University, Richmond; Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine & Rehabilitation Hospital of Indiana, Indianapolis (Drs Hammond and Katta-Charles); Spaulding Rehabilitation Network, Boston, Massachusetts (Dr Zafonte); Massachusetts General Hospital & Brigham and Women's Hospital, Boston (Dr Zafonte); Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (Dr Zafonte); and Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle (Dr Hoffman).
Insights
Chronic headache after traumatic brain injury (TBI) is linked to poorer psychosocial outcomes. Injury characteristics and socioeconomic factors predict headache development, aiding targeted clinical screening for better TBI patient care.
Area of Science:
- Neuroscience
- Clinical Psychology
- Public Health
Background:
- Headache is a common consequence of traumatic brain injury (TBI).
- Predictors of chronic headache post-TBI and its psychosocial impact are not well understood.
- Early identification of chronic headache risk factors is crucial for patient management.
Purpose of the Study:
- To identify demographic and injury-related predictors of chronic headache (HA) one or more years after moderate to severe TBI.
- To investigate the association between chronic HA and psychosocial functioning in TBI survivors.
Main Methods:
- A multisite, observational cohort study was conducted.
- LASSO regression was used for prediction modeling of chronic HA.
- Independent t tests examined associations between chronic HA and psychosocial outcomes.
Main Results:
- The LASSO model predicted chronic HA at 1-2 years with acceptable accuracy (AUC=0.70) and at 5+ years with near-acceptable accuracy (AUC=0.68).
- Predictors included sustained intracranial pressure elevation, skull fragments on CT scans, additional TBIs, lower education, younger age, female gender, and Black race.
- Chronic HA was associated with poorer emotional and participation outcomes.
Conclusions:
- Chronic headache in moderate to severe TBI survivors is linked to substantial psychosocial burden.
- Identified risk factors can inform targeted clinical screening and monitoring strategies.
- These findings may also aid in stratifying patients for future clinical trials.
Objective:
Although headache (HA) is a common sequela of traumatic brain injury (TBI), early predictors of chronic HA after moderate to severe TBI are not well established, and the relationship chronic HA has with psychosocial functioning is understudied. Thus, we sought to (1) determine demographic and injury predictors of chronic HA 1 or more years after moderate to severe TBI and (2) examine associations between chronic HA and psychosocial outcomes.
Setting:
Community.
Participants:
Participants in the TBI Model System (TBIMS) with moderate to severe TBI who consented for additional chronic pain questionnaires at the time of TBIMS follow-up.
Design:
Multisite, observational cohort study using LASSO (least absolute shrinkage and selection operator) regression for prediction modeling and independent t tests for psychosocial associations.
Main Outcome Measures:
Chronic HA after TBI at year 1 or 2 postinjury and more remotely (5 or more years).
Results:
The LASSO model for chronic HA at 1 to 2 years achieved acceptable predictability (cross-validated area under the curve [AUC] = 0.70). At 5 or more years, predictability was nearly acceptable (cross-validated AUC = 0.68), but much more complex, with more than twice as many variables contributing. Injury characteristics had stronger predictive value at postinjury years 1 to 2 versus 5 or more years, especially sustained intracranial pressure elevation (odds ratio [OR] = 3.8) and skull fragments on head computed tomography (CT) (OR = 2.5). Additional TBI(s) was a risk factor at both time frames, as were multiple socioeconomic characteristics, including lower education level, younger age, female gender, and Black race. Lower education level was a particularly strong predictor at 5 or more years (OR up to 3.5). Emotional and participation outcomes were broadly poorer among persons with chronic HA after moderate to severe TBI.
Conclusions:
Among people with moderate to severe TBI, chronic HA is associated with significant psychosocial burden. The identified risk factors will enable targeted clinical screening and monitoring strategies to enhance clinical care pathways that could lead to better outcomes. They may also be useful as stratification or covariates in future clinical trial research on treatments.
