Medication usage patterns for headache treatment after mild traumatic brain injury

Craig Ditommaso, Jeanne M. Hoffman, Sylvia Lucas, Sureyya Dikmen, Nancy Temkin, Kathleen R. Bell

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Objective To describe patient self-report of headache treatment in the first year following mild traumatic brain injury (TBI). Background An understanding of appropriate management of symptoms after mild TBI is crucial for improving acute care and long-term outcomes. This is particularly true for post-traumatic headaches as recent studies suggest that headaches after mild TBI are common with multiple phenotypes. In addition, symptoms such as headache after mild TBI are often managed by primary care providers without specialty training, and often in medically underserved areas. Outside of previous opinion papers, few studies have guided the treatment or examined the effectiveness of the interventions for post-traumatic headache. Methods One hundred sixty-seven participants admitted to a level 1 trauma hospital with mild TBI who were prospectively enrolled and reported new or worse headache at 3, 6, or 12 months after injury. Results Participants were primarily male (75%), white (75%), injured in vehicle crashes (62%), and had completed high school (83%). The majority of headaches met International Classification of Headache Disorders - 2nd edition criteria for migraine/probable migraine, followed by tension-type headache. Despite the diverse nature of headaches, more than 70% of those with headache at each time period used acetaminophen or a nonsteroidal anti-inflammatory drug for headache control. Only 8% of those with the migraine/probable migraine phenotype used triptans. Of those individuals who used medication, 26% of those with migraine/probable migraine phenotype and 70% of those with tension headache phenotype endorsed complete relief (vs partial or no relief) because of medication use. The majority of individuals with tension headache reported never taking medication. Conclusions Headaches after mild TBI are frequent and are not optimally treated. Results suggest that many individuals with mild TBI may be self-treating their headaches by utilizing over-the-counter pain relief medications. These medications, however, are only providing effective treatment for a minority of this population. Further research must be conducted to develop evidence-guided treatment and educate providers.

Original languageEnglish (US)
Pages (from-to)511-519
Number of pages9
JournalHeadache
Volume54
Issue number3
DOIs
StatePublished - 2014

Fingerprint

Brain Concussion
Headache
Migraine Disorders
Tension-Type Headache
Post-Traumatic Headache
Phenotype
Therapeutics
Medically Underserved Area
Tryptamines
Headache Disorders
Drug and Narcotic Control
Wounds and Injuries
Managed Care Programs
Long-Term Care
Acetaminophen
Self Report
Primary Health Care
Anti-Inflammatory Agents

Keywords

  • concussion
  • headache
  • migraine
  • mild traumatic brain injury
  • post-traumatic headache

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Ditommaso, C., Hoffman, J. M., Lucas, S., Dikmen, S., Temkin, N., & Bell, K. R. (2014). Medication usage patterns for headache treatment after mild traumatic brain injury. Headache, 54(3), 511-519. https://doi.org/10.1111/head.12254

Medication usage patterns for headache treatment after mild traumatic brain injury. / Ditommaso, Craig; Hoffman, Jeanne M.; Lucas, Sylvia; Dikmen, Sureyya; Temkin, Nancy; Bell, Kathleen R.

In: Headache, Vol. 54, No. 3, 2014, p. 511-519.

Research output: Contribution to journalArticle

Ditommaso, C, Hoffman, JM, Lucas, S, Dikmen, S, Temkin, N & Bell, KR 2014, 'Medication usage patterns for headache treatment after mild traumatic brain injury', Headache, vol. 54, no. 3, pp. 511-519. https://doi.org/10.1111/head.12254
Ditommaso, Craig ; Hoffman, Jeanne M. ; Lucas, Sylvia ; Dikmen, Sureyya ; Temkin, Nancy ; Bell, Kathleen R. / Medication usage patterns for headache treatment after mild traumatic brain injury. In: Headache. 2014 ; Vol. 54, No. 3. pp. 511-519.
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abstract = "Objective To describe patient self-report of headache treatment in the first year following mild traumatic brain injury (TBI). Background An understanding of appropriate management of symptoms after mild TBI is crucial for improving acute care and long-term outcomes. This is particularly true for post-traumatic headaches as recent studies suggest that headaches after mild TBI are common with multiple phenotypes. In addition, symptoms such as headache after mild TBI are often managed by primary care providers without specialty training, and often in medically underserved areas. Outside of previous opinion papers, few studies have guided the treatment or examined the effectiveness of the interventions for post-traumatic headache. Methods One hundred sixty-seven participants admitted to a level 1 trauma hospital with mild TBI who were prospectively enrolled and reported new or worse headache at 3, 6, or 12 months after injury. Results Participants were primarily male (75{\%}), white (75{\%}), injured in vehicle crashes (62{\%}), and had completed high school (83{\%}). The majority of headaches met International Classification of Headache Disorders - 2nd edition criteria for migraine/probable migraine, followed by tension-type headache. Despite the diverse nature of headaches, more than 70{\%} of those with headache at each time period used acetaminophen or a nonsteroidal anti-inflammatory drug for headache control. Only 8{\%} of those with the migraine/probable migraine phenotype used triptans. Of those individuals who used medication, 26{\%} of those with migraine/probable migraine phenotype and 70{\%} of those with tension headache phenotype endorsed complete relief (vs partial or no relief) because of medication use. The majority of individuals with tension headache reported never taking medication. Conclusions Headaches after mild TBI are frequent and are not optimally treated. Results suggest that many individuals with mild TBI may be self-treating their headaches by utilizing over-the-counter pain relief medications. These medications, however, are only providing effective treatment for a minority of this population. Further research must be conducted to develop evidence-guided treatment and educate providers.",
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AB - Objective To describe patient self-report of headache treatment in the first year following mild traumatic brain injury (TBI). Background An understanding of appropriate management of symptoms after mild TBI is crucial for improving acute care and long-term outcomes. This is particularly true for post-traumatic headaches as recent studies suggest that headaches after mild TBI are common with multiple phenotypes. In addition, symptoms such as headache after mild TBI are often managed by primary care providers without specialty training, and often in medically underserved areas. Outside of previous opinion papers, few studies have guided the treatment or examined the effectiveness of the interventions for post-traumatic headache. Methods One hundred sixty-seven participants admitted to a level 1 trauma hospital with mild TBI who were prospectively enrolled and reported new or worse headache at 3, 6, or 12 months after injury. Results Participants were primarily male (75%), white (75%), injured in vehicle crashes (62%), and had completed high school (83%). The majority of headaches met International Classification of Headache Disorders - 2nd edition criteria for migraine/probable migraine, followed by tension-type headache. Despite the diverse nature of headaches, more than 70% of those with headache at each time period used acetaminophen or a nonsteroidal anti-inflammatory drug for headache control. Only 8% of those with the migraine/probable migraine phenotype used triptans. Of those individuals who used medication, 26% of those with migraine/probable migraine phenotype and 70% of those with tension headache phenotype endorsed complete relief (vs partial or no relief) because of medication use. The majority of individuals with tension headache reported never taking medication. Conclusions Headaches after mild TBI are frequent and are not optimally treated. Results suggest that many individuals with mild TBI may be self-treating their headaches by utilizing over-the-counter pain relief medications. These medications, however, are only providing effective treatment for a minority of this population. Further research must be conducted to develop evidence-guided treatment and educate providers.

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