Headache after Moderate-to-Severe Traumatic Brain Injury

Background: Headache symptoms are a major contributor to chronic pain after moderate-to-severe traumatic brain injury (TBI). We investigated associations between headache symptoms after TBI and both psychological symptoms (depression and anxiety) and patient reported outcomes (satisfaction with life and loss of employment). Methods: A cohort of 408 individuals with moderate-to-severe TBI was prospectively followed for headache symptoms through 5 years post-injury. Cox proportional hazards regression analyses were used to examine the association between time to headache resolution or development and measures of depressive symptoms (PHQ-9) at 1 year post-injury, anxiety (GAD-7) at 2 years post-injury, satisfaction with life (SWLS) at 5 years post-injury, and loss of employment by 5 years post-injury, adjusted for potential confounding variables identified a priori. Results: Higher PHQ-9 and GAD-7 scores were associated with decreased rates of headache resolution (HR 0.93 and 0.95, respectively, per one point increase in score) and increased rates of headache development (HR 1.08 and 1.08, respectively, per on point increase in score). Higher SWLS scores were associated with increased rates of severe headache resolution (HR 1.04) and decreased rates of headache development (HR 0.96). Loss of employment was associated with increased rate of headache development (HR 3.14). Conclusions: Greater symptoms of depression and anxiety after TBI were associated with headache supporting processes. The findings invite new investigation into depression and anxiety as risk factors for long-term headache after TBI and highlight the impact such headaches have on patient outcomes.