Post traumatic headache following mild traumatic brain injury

Steven Faux, J Sheedy, R Primavesi, S Delaney, R Riopelle

1Heart Rehabilitation Unit
2Vincent's Hospital, Sydney, Australia
3Emergency Medicine, McGill University Health Centre, Montreal General Hospital, Montreal Canada.
4 Emergency Medicine, McGill University Health Centre, Montreal General Hospital, Montreal Canada.

A prospective controlled study at St Vincent's Hospital Sydney in 2005 found the incidence of Post Traumatic Headache (PTHA) persisting for more than 3 months following Mild Traumatic Brain Injury (MTBI) was 15.35%. A cross validation study was performed in Montreal Canada to assess generaliseability. 90% of all Traumatic Brain Injury is mild and represents the most common neurosurgical presentations.Its sequelae presents, a large burden to chronic pain clinics.
Methods: In Sydney 100 matched controls and 100 patient suffering MTBI were assessed in the emergency ward (ER) prior to discharge when cognitive testing and recording of pain levels were undertaken. Phone follow-up was undertaken and 1 and 3 months for data collection. In Montreal, 18 months later 107 consecutive patients suffering MTBI were assessed in the emergency department and followed up using the same methodology with an expanded data set.
Results: The incidence of PTHA in the Montreal Cohort was 13.15% (no significant difference) confirming the Sydney results. When the data was grouped having a Visual Analogue Score of Headache greater than 4.5/10 was a significant predictor of Persistent pain at 3 months and interestingly a predictor of likelihood of suffering Post Concussive Syndrome (PCS). Effects of alcohol consumption and pain patterns will be described.
Conclusion; This International prospective controlled study demonstrates that the incidence of PTHA following MTBI is likely to be13-15% (much lower than previous estimates) and that VAS Headache scores of over 4/10 at the time of discharge from ER is an independent predictor of persistent PTHA and Post Concussive Syndrome. Pain levels above 4.5/10 VAS at the time of discharge from ER may be indicative of more serious cerebral injury. More effective analgesia and early referral of these patients may avert symptom chronicity.