From the Guidelines
Yes, headache is a sign of Traumatic Brain Injury (TBI) in adults.
Headache as a Symptom of TBI
Headache is a common symptom of TBI, and it is often included as a criterion in clinical decision tools used to assess patients with mild head injury. For example, the New Orleans Criteria (NOC) includes headache as one of the 7 findings that are associated with an increased risk of clinically important brain injury [ 1 ]. Similarly, the Canadian CT Head Rule (CCHR) includes headache as a symptom that may indicate the need for a head CT scan [ 1 ].
Clinical Decision Tools
Several clinical decision tools have been developed to help emergency physicians assess patients with mild head injury and determine the need for imaging or other interventions. These tools, such as the CCHR and NOC, use a combination of clinical findings, including symptoms like headache, to stratify patients into high- or low-risk categories [ 1 ]. The NEXUS Head CT decision instrument is another tool that has been shown to be effective in identifying patients who are at low risk of clinically important brain injury and can safely be discharged without imaging [ 1 ].
Importance of Headache in TBI Assessment
While headache is an important symptom of TBI, it is not the only factor that should be considered when assessing patients with mild head injury. Other symptoms, such as vomiting, amnesia, and disorientation, should also be taken into account [ 1 ]. Additionally, the presence of certain risk factors, such as age over 60 years or the use of anticoagulant medications, may increase the likelihood of clinically important brain injury and should be considered when making decisions about imaging or other interventions [ 1 ].
Limitations of Current Evidence
While the current evidence suggests that headache is a sign of TBI in adults, there are limitations to the available data. Many of the studies that have investigated the use of clinical decision tools in patients with mild head injury have been limited by methodological flaws, such as selection bias or incomplete follow-up [ 1 ]. Further research is needed to fully understand the role of headache in the assessment of TBI and to develop more effective clinical decision tools.
From the Research
Prevalence of Headache in TBI
- Headache is a prevalent symptom following traumatic brain injury (TBI), with studies indicating that 18-58% of those suffering a TBI will have significant headache at 1 year following the trauma 2.
- A large-scale prospective cohort study found that 59.3% of patients reported acute headache at study enrolment, with similar frequencies across all strata 3.
- The prevalence of headache remains high over the first year, with more than 41% of participants reporting headache at 3,6, and 12 months post-injury 4.
Predictors of Headache in TBI
- Female patients and those aged up to 40 years reported a higher frequency of headache at baseline compared to males and older adults 3.
- Younger age, more severe TBI, fatigue, neck pain, and vision problems were among the predictors of more severe headache over time 3.
- A prior history of headache is associated with a higher risk for posttraumatic headache (PTH) 4, 5.
Clinical Characterization of Headache in TBI
- Most PTH has clinical diagnostic criteria meeting that of migraine or probable migraine when primary headache disorder classification criteria are used, followed by tension-type headache 5.
- The frequency of severe headache was highest in patients admitted to the ICU 3.
- Disability related to headache was high, with average headache pain ranging from 5.5 at baseline to 5.7 at 60 months post-injury, and reports of substantial impact on daily life across all time points 6.
Long-term Effects of Headache in TBI
- Headache is a substantial problem after TBI, with results suggesting that ongoing assessment and treatment of headache after TBI is needed, as this symptom may be a problem up to 5 years post-injury 6.
- More than 25% of patients experienced headache at 12 months after injury, and new or worse headache prevalence remained consistent with at least 33% at all time points up to 5 years after injury 3, 6.