Headache Trigger Sensitivity and Avoidance after Mild Traumatic Brain Injury

Noah D. Silverberg, Paul Martin, William J. Panenka

Research output: Contribution to journalArticleResearchpeer-review

12 Citations (Scopus)

Abstract

Most patients with primary headache disorders identify environmental stimuli (e.g., visual glare), situational factors (e.g., stress), physiological states (e.g., hormones), or activities (e.g., exercise) as triggers that elicit or worsen headache episodes. Headache triggers have not been previously studied in post-traumatic headache (PTH). The present study explored the frequency of headache triggers and their avoidance in PTH. Participants with mild traumatic brain injury (TBI) were recruited from outpatient specialty clinics and completed questionnaires at or soon after their initial clinic visit. The research assessment included a list of 12 possible headache triggers where participants were asked to rate sensitivity (how often they get a headache when exposed to the trigger) and avoidance (how often they try to avoid the trigger). Enrolled participants were 40.6 years old (standard deviation [SD] = 11.8 years) on average, predominantly female (69.8%) and Caucasian (69.8%), and injured in a motor vehicle crash (47.2%) or fall (20.8%). They were assessed at 9.4 weeks (SD = 6.8) post-injury. Most patients with mild TBI in this consecutive series (82.7%) reported ongoing headaches. Mental exertion, stress, and lack of sleep were rated as the most potent headache triggers and among the most frequently avoided. Odors or foods, hunger, and weather conditions were rated as the least potent triggers. Headache trigger sensitivity and avoidance were moderately correlated (r = 0.736, p < 0.001). Headache severity was more associated with trigger sensitivity [F(2,49) = 13.45, p < 0.001] than trigger avoidance [F(2,47) = 2.97, p = 0.062]. In summary, the pattern of headache triggers in persistent PTH after mild TBI appears somewhat different from that in primary headache disorders, with mental exertion emerging as uniquely important. Pervasive avoidance of mental exertion to prevent headaches (cogniphobia) might be a worthwhile behavioral intervention target after mild TBI.

Original languageEnglish
Pages (from-to)1544-1550
Number of pages7
JournalJournal of Neurotrauma
Volume36
Issue number10
DOIs
Publication statusPublished - 15 May 2019
Externally publishedYes

Keywords

  • brain concussion
  • craniocerebral trauma
  • headache
  • post-concussion syndrome
  • post-traumatic headache

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