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Referral Gaps and Risk Factors for Long-Term Headaches in Patients with Craniofacial Fractures
Bashar A Hassan1,2, Grishma Patel3, Eric Resnick3
1Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, Maryland.
Plastic and Reconstructive Surgery
|February 27, 2026
Summary
Post-traumatic headache (PTH) is common after craniofacial trauma. Early neurology referral is crucial for patients with pre-existing headaches or abnormal CT scans to prevent long-term PTH.
Area of Science:
- Trauma surgery
- Neurology
- Headache medicine
Background:
- Post-traumatic headache (PTH) affects up to 80% of mild-to-moderate traumatic brain injury (TBI) patients, causing significant morbidity.
- Low neurology referral rates hinder timely diagnosis and treatment, potentially leading to persistent headaches.
- Craniofacial trauma patients often experience PTH, necessitating better management strategies.
Purpose of the Study:
- Identify risk factors for developing post-traumatic headache (PTH) lasting over one year.
- Assess the frequency of neurology referrals in patients with craniofacial trauma and PTH.
- Evaluate the impact of early neurology referral on long-term PTH outcomes.
Main Methods:
- Retrospective review of adult patients with frontal sinus, orbital, or mandibular fractures (2018-2019).
- Primary outcome: frequency of persistent or new-onset PTH assessed >1 year post-injury.
- Multivariable logistic regression used to determine risk factors for long-term PTH.
Main Results:
- Of 622 patients, 166 (27%) had PTH and 310 (50%) had TBI-related symptoms; 80% were not referred to neurology.
- Among referred patients with follow-up >1 year, 12% reported persistent or new-onset PTH.
- Pre-trauma headaches (aOR 5) and abnormal head CT (aOR 4) were significant risk factors for PTH >1 year.
Conclusions:
- Patients with craniofacial fractures require vigilant PTH monitoring, especially those with pre-trauma headaches or abnormal CT scans.
- Early neurology referral is recommended to prevent long-term morbidity associated with PTH.
- Addressing PTH in craniofacial trauma is critical for improving patient outcomes and reducing healthcare burden.
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