Which Matters More? A Retrospective Cohort Study of Headache Characteristics and Diagnosis Type in Soldiers with mTBI/Concussion

Finkel, Alan G.; Ivins, Brian; Yerry, Juanita A.; Klaric, John; Scher, Ann I.; Choi, Y. Sammy

doi:10.1111/head.13056

Cited by 17 publications

(21 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There are many questions and some controversy regarding the use of symptom profiles to classify or type PTH. 6 Furthermore, symptom profiles of patients with PTH are heterogeneous, and the profiles of multiple primary headache conditions appear to predominate concurrently in many of these individuals 7,8 and thus do not sit well or are not classifiable within existing primary diagnostic criteria. Should we classify these symptom profiles, as suggested by the ICHD, with respect to the primary headache syndromes?…”

Section: Introductionmentioning

confidence: 99%

“…12 Derek Denny-Brown described PTH in 200 consecutive head injury patients at Boston City Hospital in 1944. 7,8,[14][15][16][17][18] Some studies excluded subjects with mixed headaches. They were variable in severity and described as steady, throbbing, aching, dull, burning, or pressing.…”

Section: Introductionmentioning

confidence: 99%

“…Finkel's study 8 showed the value in using classification to associate occupational outcomes with diagnosis "type" as well as with the presence of continuous headache. These patients with continuous headache were said to have "embedded migraine type."…”

Section: Introductionmentioning

confidence: 99%

“…Several studies 8,17,18,21 commented that onset between a week and a month was not rare. The ICHD-2 requires that the onset of headache should be less than a week after the head injury.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Posttraumatic Headache: Classification by Symptom‐Based Clinical Profiles

Lucas

Ahn

2018

Headache

View full text Add to dashboard Cite

There are currently no accepted therapies for posttraumatic headache (PTH). In order to meet the urgent need for effective therapies for PTH, we must continue to address fundamental gaps in our understanding of the clinical course and impact of PTH. Here we examine the existing schema used to characterize the clinical characteristics of PTH, including the International Classification of Headache Disorders (ICHD). There remain unresolved questions about whether to classify patients based on the extent of brain injury or on clinical symptom profiles. There also remain problematic issues of definition such as continuous headache, and chronic daily headache with features of "embedded" migraine-type within these headaches, which will need to be studied further. We make the case that a symptom-based classification is needed to begin an examination of these unresolved questions, and to establish clinically relevant endpoints for research and clinical trials for effective therapies.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Several studies 8,17,18,21 commented that onset between a week and a month was not rare. The ICHD-2 requires that the onset of headache should be less than a week after the head injury.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Posttraumatic Headache: Classification by Symptom‐Based Clinical Profiles

Lucas

Ahn

2018

Headache

View full text Add to dashboard Cite

show abstract

“…An evidence‐based review by Holtkamp, Grimes, and Ling also showed that post‐traumatic headache with features of migraine was the most frequently occurring symptom after mild traumatic brain injury. A recent retrospective study by Finkel et al found that 60% of their post‐traumatic headache cohort was consistent with migraine among the 166 distinct headache types identified. Service members in the U.S. military have also demonstrated a high prevalence of chronic, daily headaches after concussion usually resembling chronic migraine and strongly associated with co‐morbid post‐traumatic stress disorder (PTSD) …”

Section: Introductionmentioning

confidence: 99%

Impact of Pre‐Existing Migraine and Other Co‐Morbid or Co‐Occurring Conditions on Presentation and Clinical Course Following Deployment‐Related Concussion

2020

View full text Add to dashboard Cite

Objective To describe the clinical presentation and early clinical course of a sample of deployed U.S. military service members following concussion, underscoring the impact of pre‐existing migraine and other co‐occurring conditions. It is important to obtain a comprehensive clinical history to identify evidence of underlying migraine and other health conditions which may contribute to an individual’s presenting symptoms influencing early management and outcomes following concussion. Early outcome measures assessed include headache treatment response and fitness for return to duty. Background Acute concussion is reported to result in an array of somatic, cognitive, and behavioral symptoms. It is well established that these symptoms are not specific for concussion and may result from exacerbation of pre‐existing or underlying medical conditions and factors. Although most symptoms attributable to concussion resolve within days to weeks, there is evidence that persistent symptoms beyond that specific recovery time may be attributable to factors other than concussion. Military populations are at risk for a number of recognized co‐morbid and co‐occurring conditions, as well as special situational and psychosocial factors which may influence symptoms and clinical course following concussion. In addition, combat‐related concussion frequently occurs in the setting of a blast or military vehicle accidents thus causing concurrent injuries where musculoskeletal injuries may contribute to the clinical presentation. The resultant acute stress reaction, secondary to the traumatic experience associated with concussion, may also cause or aggravate underlying psychological co‐morbidities that may influence presenting symptoms. Prior studies identified co‐morbidities associated with chronic post‐concussive syndrome, which we find are also present during the early phase following deployment‐related concussion, thereby influencing presentation and impacting recovery. This retrospective chart review was intended to demonstrate the presence and potential impact of co‐morbid and co‐occurring conditions contributing to symptoms following concussion, especially migraine due to its high prevalence among post‐traumatic headaches. Methods Retrospective chart review was performed by the treating neurologist of 40 service members following concussion in the deployed environment. Clinical symptoms and co‐morbid and co‐occurring conditions including evidence of pre‐existing migraine identified during comprehensive neurologic evaluations were collected. Both pre‐deployment/pre‐traumatic and post‐traumatic headache features supporting migraine and early instituted headache management and treatment response are described. Rates of return to duty in this sample were also tabulated. Results Headaches were the most frequently reported acute symptom following concussion in this deployed service member population (38/40 patients [98%]), followed by insomnia, tinnitus, impaired concentration, nausea, dizziness, anxiety, impaired balance, depression, and...

show abstract

Clinical Perspectives on Headache After Traumatic Brain Injury

Hoffman

Lucas

Dikmen

et al. 2020

PM&R

View full text Add to dashboard Cite

Background: Headache after traumatic brain injury (TBI) is frequent and persistent over the first year after injury. Providers may need to focus on different symptom presentations depending on their patient's TBI severity. Objective: We evaluated headache symptoms in patients with moderate-to-severe TBI compared to patients with mild TBI and examined our data from two perspectives: (1) from providers who treat individuals after TBI and manage multiple postinjury symptoms including headache, and (2) from headache specialists who see individuals after TBI to manage headache. Design: Prospective enrollment of individuals after TBI with telephone follow-up at 1-year postinjury. Setting: Enrollment from hospital and then community followup. Participants: Three hundred forty-six individuals with moderate-to-severe TBI were enrolled during acute inpatient rehabilitation across seven TBI Model System Centers. One hundred eighty-nine individuals with mild TBI were enrolled within 1 week of injury at a single center. Intervention: None. Main Outcome Measurements: Headache frequency, headache type, pain intensity, Headache Impact Test-6 (HIT-6), and depressive symptoms measured 1 year after injury. Results: Headache prevalence is high in both TBI groups. TBI providers are more likely to evaluate and treat headache from individuals sustaining a mild TBI versus moderate-to-severe TBI. Patients with mild TBI are most likely to report tension-type headache followed by migraine-type headache. The migraine-type headache has higher impact (HIT-6) and greater pain intensity. Headache specialists may encounter patients with moderate-to-severe TBI who report more frequent headache and higher average pain scores compared to patients with mild TBI. The severity of TBI was unrelated to depressive symptoms 1 year after injury, but patients with headache were significantly more likely to have higher scores. Conclusions: TBI providers versus headache specialists should be aware of differences in patient symptom presentation to their respective clinics. Ongoing assessment of headache and depression over time is important following TBI of any severity.

show abstract

Which Matters More? A Retrospective Cohort Study of Headache Characteristics and Diagnosis Type in Soldiers with mTBI/Concussion

Cited by 17 publications

References 24 publications

Posttraumatic Headache: Classification by Symptom‐Based Clinical Profiles

Posttraumatic Headache: Classification by Symptom‐Based Clinical Profiles

Impact of Pre‐Existing Migraine and Other Co‐Morbid or Co‐Occurring Conditions on Presentation and Clinical Course Following Deployment‐Related Concussion

Clinical Perspectives on Headache After Traumatic Brain Injury

Contact Info

Product

Resources

About