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Medication Usage Patterns for Headache Treatment After Mild Traumatic Brain Injury

Authors

  • Craig DiTommaso MD,

    Corresponding author
    1. Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
    • Address all correspondence to C. DiTommaso, Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195-6490, USA, email: craig.ditommaso@gmail.com

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  • Jeanne M. Hoffman PhD,

    1. Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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  • Sylvia Lucas MD, PhD,

    1. Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
    2. Department of Neurology, University of Washington, Seattle, WA, USA
    3. Department of Neurological Surgery, University of Washington, Seattle, WA, USA
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  • Sureyya Dikmen PhD,

    1. Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
    2. Department of Neurological Surgery, University of Washington, Seattle, WA, USA
    3. Department of Psychiatry and Behavioral Medicine, University of Washington, Seattle, WA, USA
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  • Nancy Temkin PhD,

    1. Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
    2. Department of Neurological Surgery, University of Washington, Seattle, WA, USA
    3. Department of Biostatistics, University of Washington, Seattle, WA, USA
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  • Kathleen R. Bell MD

    1. Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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  • Conflict of Interest: Dr. DiTommaso has no conflicts of interest to disclose. Dr. Hoffman receives research funding from NIDRR and Department of Defense. Dr. Lucas receives funding from NIDRR, Department of Defense, the Wadsworth Foundation, St. Jude Medical Inc., and BiogenIdec. She has received consulting fees or honoraria from Zogenix, MAP, Allergan, BiogenIdec, Genzyme, and Novartis. Dr. Dikmen receives research funding from NIDRR, Department of Defense, and NIH. Dr. Temkin receives research funding from NIDRR, Department of Defense, and NIH. Dr. Bell receives research funding from NIDRR and Department of Defense.
  • This study was funded by the Department of Education, National Institute on Disability and Rehabilitation Research, grant number H133G090022. The Department of Education provided funding, but had no role in the study design, data collection, or writing of the paper.

Abstract

Objective

To describe patient self-report of headache treatment in the first year following mild traumatic brain injury (TBI).

Background

An understanding of appropriate management of symptoms after mild TBI is crucial for improving acute care and long-term outcomes. This is particularly true for post-traumatic headaches as recent studies suggest that headaches after mild TBI are common with multiple phenotypes. In addition, symptoms such as headache after mild TBI are often managed by primary care providers without specialty training, and often in medically underserved areas. Outside of previous opinion papers, few studies have guided the treatment or examined the effectiveness of the interventions for post-traumatic headache.

Methods

One hundred sixty-seven participants admitted to a level 1 trauma hospital with mild TBI who were prospectively enrolled and reported new or worse headache at 3, 6, or 12 months after injury.

Results

Participants were primarily male (75%), white (75%), injured in vehicle crashes (62%), and had completed high school (83%). The majority of headaches met International Classification of Headache Disorders – 2nd edition criteria for migraine/probable migraine, followed by tension-type headache. Despite the diverse nature of headaches, more than 70% of those with headache at each time period used acetaminophen or a nonsteroidal anti-inflammatory drug for headache control. Only 8% of those with the migraine/probable migraine phenotype used triptans. Of those individuals who used medication, 26% of those with migraine/probable migraine phenotype and 70% of those with tension headache phenotype endorsed complete relief (vs partial or no relief) because of medication use. The majority of individuals with tension headache reported never taking medication.

Conclusions

Headaches after mild TBI are frequent and are not optimally treated. Results suggest that many individuals with mild TBI may be self-treating their headaches by utilizing over-the-counter pain relief medications. These medications, however, are only providing effective treatment for a minority of this population. Further research must be conducted to develop evidence-guided treatment and educate providers.

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