Greater Severity and Functional Impact of Post-Traumatic Headache in Veterans with Comorbid Neck Pain following Traumatic Brain Injury

Purpose/Hypothesis: Traumatic brain injury (TBI) affects 1.7 million people in the U.S. annually, the majority being mild in severity (mTBI). Post-traumatic headache (PTH) is one of the most common symptoms experienced after mTBI caused by head or neck trauma and is often refractory to treatment. Although military Veterans commonly experience mTBI after blast or blunt injuries that likely affect musculoskeletal structures in the neck, the prevalence of cervical symptoms in Veterans with PTH following mTBI have not been well characterized. Similarly, the impact of comorbid neck pain on physical and psychosocial functioning in this population is unknown. This study aims to assess the prevalence of neck pain in Veterans with PTH following mTBI, and to compare the severity and functional impact of PTH between those with and without comorbid neck pain. Number of Subjects: 33 Veterans with PTH after a military-related mTBI were identified from a secondary analysis of data from a prior study. Materials and Methods: Participants were determined to have PTH if they responded to questions on the Patient Headache History Questionnaire (PHHQ), attributed PTH to an accident or injury, and reported PTH in the TBI history. Individuals with both PTH and comorbid neck pain (PTH+NP) were identified based on an affirmative response to one or more questions on the PHHQ indicating that HA episodes were either preceded or accompanied by neck pain. Standardized measures of HA severity and frequency, insomnia, fatigue, mood disorders (Depression, Anxiety, and Posttraumatic Stress Disorder), and physical and emotional role function (SF-36) were compared between groups with and without comorbid neck pain. Results: Of the 33 participants with PTH, 22 (67%) also had neck pain. There were no differences in demographic or TBI-specific characteristics between groups (p>0.069). Sixty-three percent of the PTH+NP group reported severe or incapacitating HA, compared to 27% of those with PTH alone (P=0.049). Insomnia severity and fatigue were significantly greater in the PTH+NP group (P 0.326). Conclusions: The majority of Veterans with mTBI and PTH reported comorbid neck pain. Veterans with PTH and NP reported increased severity of HA, insomnia, fatigue, and a greater physical, but not emotional functional limitations compared to those without NP.