Category: Brain Injury; Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
To describe the recovery trajectory of headache occurring after concussion in an adult, non-compensation seeking, heterogeneous population and to determine which comorbid factors are predictive of prolonged recovery.
Design : A naturalistic observational cohort study with clinic visits at Weeks 1, 2, 4, 6, 8, 12, and 16 after a concussion. Visits included physician assessments, neurocognitive assessments, balance assessments, and symptom questionnaires.
A hospital-based outpatient rapid-access concussion clinic in Toronto, Canada.
Participants (or Animals, Specimens, Cadavers) : Adults 17 – 85 years with a diagnosed concussion, seen in clinic by clinic physician within a week of injury. Patients with positive CT findings, workplace or motor vehicle collision related injuries were excluded. 303 individuals were included.
Interventions : Not applicable.
Main Outcome Measure(s) :
Time to return to pre-injury headache frequency and intensity based upon self-report post-concussion headache questionnaires.
Over 90% of individuals with a concussion reported a headache in the first week post-injury. The headache frequency was greater than pre-injury baseline for the first 6 weeks post-injury. 90% of participants returned to their reported baseline headache frequency by Week 16. Individuals with a history of migraine were 3.5 times more likely to endorse ongoing headaches Week 8 – 16 post-injury (p=0.0017) and reported higher headache intensity than those without history of migraine (p<0.0001). Females were also more likely to endorse a headache Weeks 6 – 16 than males (p=0.001). Pearson correlation with anxiety measures (r=0.50, p<0.0001) and sleep disorders (r=0.60, p<0.0001) associated with prolonged headache endorsement.
Headache is the most common symptom after a headache. Fortunately, most individuals return to their pre-injury headache baseline as the concussion resolves. History of migraines, being female, having anxiety, and sleep disorders increase the risk of prolonged recovery.
Laura Langer– Research Analyst, Toronto Rehab - University Health Network, Toronto, Ontario
Jonathan Gladstone– Consultant Neurologist, Toronto Rehab - University Health Network, Toronto, Ontario
Paul Comper– Neuropsychologist, Toronto Rehab - University Health Network, Toronto, Ontario
Tharshini Chandra– Project Manager, Toronto Rehab - University Health Network, Toronto, Ontario
Evan Foster– Research Assistant, UHN - Toronto Rehabiliation Institute, Toronto, Ontario
Mark Bayley– Medical Director, UHN-Toronto Rehabilitation Institute, Toronto, Ontario
David Lawrence– Physician, Toronto Rehab - University Health Network, Toronto, Ontario