scholarly journals Greater Severity and Functional Impact of Post-traumatic Headache in Veterans With Comorbid Neck Pain Following Traumatic Brain Injury

2020 ◽  
Author(s):  
Bahar Shahidi ◽  
Robyn W Bursch ◽  
Jennifer S Carmel ◽  
Ashleigh C Carranza ◽  
Kelsey M Cooper ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Neck Pain ◽  
Physical Functioning ◽  
Bodily Pain ◽  
Blunt Injury ◽  
Convenience Sample ◽  
Emotional Role ◽  
Physical Limitations ◽  
Post Traumatic

ABSTRACT Background Post-traumatic headache (PTH) is a commonly experienced symptom after mild traumatic brain injury (mTBI). Blast injury– or blunt injury–related mechanisms for mTBI in veterans can also affect musculoskeletal structures in the neck, resulting in comorbid neck pain (NP). However, it is unknown whether the presence of comorbid NP may be associated with a different pattern of headache symptoms, physical functioning, or emotional functioning compared to those without comorbid NP. The purpose of this study is to examine the role of comorbid NP in veterans with mTBI and PTH. Design and Methods This was a cross-sectional investigation of an existing dataset that included 33 veterans who met inclusion criteria for PTH after mTBI. Standardized measures of headache severity and frequency, insomnia, fatigue, mood disorders, and physical and emotional role function were compared between groups with and without comorbid NP. Results The majority of participants with PTH reported comorbid NP (n = 22/33, 67%). Those with comorbid NP experienced more headache symptoms that were severe or incapacitating, as compared to mild or moderate for those without NP (φ = 0.343, P = .049); however, no differences in headache frequency (φ = 0.231, P = .231) or duration (φ = 0.129, P = .712) were observed. Participants with comorbid NP also reported greater insomnia (d = 1.16, P = .003) and fatigue (d = 0.868, P = .040) as well as lower physical functioning (d = 0.802, P = .036) and greater bodily pain (d = 0.762, P = .012). There were no differences in anxiety, depression, mental health, emotional role limitations, vitality, or social functioning between those with and without comorbid NP (d ≤ 0.656, P ≥ .079). Conclusions A majority of veterans with mTBI and PTH in our sample reported comorbid NP that was associated with greater headache symptom severity and physical limitations, but not with mood or emotional limitations. Preliminary findings from this small convenience sample indicate that routine assessment of comorbid NP and associated physical limitations should be considered in veterans with mTBI and PTH.

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

2020 ◽  
Author(s):  
Bahar Shahidi ◽  
Robyn W Bursch ◽  
Jennifer S Carmel ◽  
Ashleigh C Carranza ◽  
Kelsey M Cooper ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Neck Pain ◽  
Psychosocial Functioning ◽  
Bodily Pain ◽  
Functional Impact ◽  
Role Function ◽  
Emotional Role ◽  
Post Traumatic ◽  
The Impact

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<0.040), and physical function due to bodily pain and physical role function was significantly lower in the PTH+NP group (P<0.036). There were no significant differences between groups for any of the mood or emotional-role functioning scales (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.

Time Interval Between Traumatic Brain Injury And Post Traumatic Epilepsy

2013 ◽  
Vol 21 (2) ◽  
pp. 222-228
Author(s):  
Daniel Garbin Di Luca ◽  
Glenda Corrêa Borges de Lacerda
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
First Year ◽  
Time Interval ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Post Traumatic ◽  
Faster Development ◽  
Post Traumatic Epilepsy ◽  
Traumatic Epilepsy

Introduction. The estimated time interval in which an individual can develop Post Traumatic Epilepsy (PTE) after a traumatic brain injury (TBI) is not clear. Objective. To assess the possible influence of the clinical features in the time interval between TBI and PTE develop­ment. Method. We analyzed retrospectively 400 medical records from a tertiary Brazilian hospital. We selected and reevaluated 50 patients and data was confronted with the time between TBI and PTE devel­opment by a Kaplan-Meier survival analysis. A Cox-hazard regression was also conducted to define the characteristics that could be involved in the latent period of the PTE development. Results. Patients devel­oped PTE especially in the first year (56%). We found a tendency of a faster development of PTE in patients older than 24 years (P<0.0001) and in men (P=0.03). Complex partial seizures evolving to generalized seizures were predominant in patients after moderate (37.7%) and severe (48.8%) TBIs, and simple partial seizures evolving to general­ized seizures in mild TBIs (45.5%). Conclusions. Our data suggest that the first year after a TBI is the most critical period for PTE de­velopment and those males older than 24 years could have a faster development of PTE.

scholarly journals Cervicovestibular rehabilitation in adult with mild traumatic brain injury: a randomised controlled trial protocol

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Pierre Langevin ◽  
Philippe Fait ◽  
Pierre Frémont ◽  
Jean-Sébastien Roy
Keyword(s):  
Traumatic Brain Injury ◽  
Cervical Spine ◽  
Brain Injury ◽  
Neck Pain ◽  
Mild Traumatic Brain Injury ◽  
Controlled Trial ◽  
Rehabilitation Program ◽  
Conventional Approach ◽  
Persistent Symptoms ◽  
Link Type

Abstract Background Mild traumatic brain injury (mTBI) is an acknowledged public health problem. Up to 25% of adult with mTBI present persistent symptoms. Headache, dizziness, nausea and neck pain are the most commonly reported symptoms and are frequently associated with cervical spine and vestibular impairments. The most recent international consensus statement (2017 Berlin consensus) recommends the addition of an individualized rehabilitation approach for mTBI with persistent symptoms. The addition of an individualized rehabilitation approach including the evaluation and treatment of cervical and vestibular impairments leading to symptoms such as neck pain, headache and dizziness is, however, recommended based only on limited scientific evidence. The benefit of such intervention should therefore be further investigated. Objective To compare the addition of a 6-week individualized cervicovestibular rehabilitation program to a conventional approach of gradual sub-threshold physical activation (SPA) alone in adults with persistent headache, neck pain and/or dizziness-related following a mTBI on the severity of symptoms and on other indicators of clinical recovery. We hypothesize that such a program will improve all outcomes faster than a conventional approach (between-group differences at 6-week and 12-week). Methods In this single-blind, parallel-group randomized controlled trial, 46 adults with subacute (3 to12 weeks post-injury) persistent mTBI symptoms will be randomly assigned to: 1) a 6-week SPA program or 2) SPA combined with a cervicovestibular rehabilitation program. The cervicovestibular rehabilitation program will include education, cervical spine manual therapy and exercises, vestibular rehabilitation and home exercises. All participants will take part in 4 evaluation sessions (baseline, week 6, 12 and 26) performed by a blinded evaluator. The primary outcome will be the Post-Concussion Symptoms Scale. The secondary outcomes will be time to clearance to return to function, number of recurrent episodes, Global Rating of Change, Numerical Pain Rating Scale, Neck Disability Index, Headache Disability Inventory and Dizziness Handicap Inventory. A 2-way ANOVA and an intention-to-treat analysis will be used. Discussion Controlled trials are needed to determine the best rehabilitation approach for mTBI with persistent symptoms such as neck pain, headache and dizziness. This RCT will be crucial to guide future clinical management recommendations. Trial registration ClinicalTrials.gov Identifier - NCT03677661, Registered on September, 15th 2018.

Association of Ventilation during Initial Trauma Resuscitation for Traumatic Brain Injury and Post-Traumatic Outcomes: A Systematic Review

2021 ◽  
pp. 1-6
Author(s):  
Mary Beth Howard ◽  
Nichole McCollum ◽  
Emily C. Alberto ◽  
Hannah Kotler ◽  
Mary E. Mottla ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Trauma Resuscitation ◽  
Cerebral Herniation ◽  
Full Text Review ◽  
Post Traumatic ◽  
Ventilation Strategies ◽  
End Tidal

Abstract Objectives: In the absence of evidence of acute cerebral herniation, normal ventilation is recommended for patients with traumatic brain injury (TBI). Despite this recommendation, ventilation strategies vary during the initial management of patients with TBI and may impact outcome. The goal of this systematic review was to define the best evidence-based practice of ventilation management during the initial resuscitation period. Methods: A literature search of PubMed, CINAHL, and SCOPUS identified studies from 2009 through 2019 addressing the effects of ventilation during the initial post-trauma resuscitation on patient outcomes. Results: The initial search yielded 899 articles, from which 13 were relevant and selected for full-text review. Six of the 13 articles met the inclusion criteria, all of which reported on patients with TBI. Either end-tidal carbon dioxide (ETCO2) or partial pressure carbon dioxide (PCO2) were the independent variables associated with mortality. Decreased rates of mortality were reported in patients with normal PCO2 or ETCO2. Conclusions: Normoventilation, as measured by ETCO2 or PCO2, is associated with decreased mortality in patients with TBI. Preventing hyperventilation or hypoventilation in patients with TBI during the early resuscitation phase could improve outcome after TBI.

scholarly journals Depression following traumatic brain injury: a comprehensive overview

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Marc Fakhoury ◽  
Zaynab Shakkour ◽  
Firas Kobeissy ◽  
Nada Lawand
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Health Concern ◽  
First Year ◽  
Comprehensive Overview ◽  
Symptoms Of Depression ◽  
Current State ◽  
Post Traumatic ◽  
Brain Changes

Abstract Traumatic brain injury (TBI) represents a major health concern affecting the neuropsychological health; TBI is accompanied by drastic long-term adverse complications that can influence many aspects of the life of affected individuals. A substantial number of studies have shown that mood disorders, particularly depression, are the most frequent complications encountered in individuals with TBI. Post-traumatic depression (P-TD) is present in approximately 30% of individuals with TBI, with the majority of individuals experiencing symptoms of depression during the first year following head injury. To date, the mechanisms of P-TD are far from being fully understood, and effective treatments that completely halt this condition are still lacking. The aim of this review is to outline the current state of knowledge on the prevalence and risk factors of P-TD, to discuss the accompanying brain changes at the anatomical, molecular and functional levels, and to discuss current approaches used for the treatment of P-TD.

scholarly journals Altered speech patterns in subjects with post-traumatic headache due to mild traumatic brain injury

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Catherine D. Chong ◽  
Jianwei Zhang ◽  
Jing Li ◽  
Teresa Wu ◽  
Gina Dumkrieger ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Speech Production ◽  
Mild Traumatic Brain Injury ◽  
Mobile Application ◽  
Speaking Rate ◽  
Mixed Effect ◽  
Effect Model ◽  
Vowel Space ◽  
Post Traumatic

Abstract Background/objective Changes in speech can be detected objectively before and during migraine attacks. The goal of this study was to interrogate whether speech changes can be detected in subjects with post-traumatic headache (PTH) attributed to mild traumatic brain injury (mTBI) and whether there are within-subject changes in speech during headaches compared to the headache-free state. Methods Using a series of speech elicitation tasks uploaded via a mobile application, PTH subjects and healthy controls (HC) provided speech samples once every 3 days, over a period of 12 weeks. The following speech parameters were assessed: vowel space area, vowel articulation precision, consonant articulation precision, average pitch, pitch variance, speaking rate and pause rate. Speech samples of subjects with PTH were compared to HC. To assess speech changes associated with PTH, speech samples of subjects during headache were compared to speech samples when subjects were headache-free. All analyses were conducted using a mixed-effect model design. Results Longitudinal speech samples were collected from nineteen subjects with PTH (mean age = 42.5, SD = 13.7) who were an average of 14 days (SD = 32.2) from their mTBI at the time of enrollment and thirty-one HC (mean age = 38.7, SD = 12.5). Regardless of headache presence or absence, PTH subjects had longer pause rates and reductions in vowel and consonant articulation precision relative to HC. On days when speech was collected during a headache, there were longer pause rates, slower sentence speaking rates and less precise consonant articulation compared to the speech production of HC. During headache, PTH subjects had slower speaking rates yet more precise vowel articulation compared to when they were headache-free. Conclusions Compared to HC, subjects with acute PTH demonstrate altered speech as measured by objective features of speech production. For individuals with PTH, speech production may have been more effortful resulting in slower speaking rates and more precise vowel articulation during headache vs. when they were headache-free, suggesting that speech alterations were related to PTH and not solely due to the underlying mTBI.

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