PTSD a Valuable Predictor for Headache-Related Disability in Patients With Traumatic Physical Injury

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Headache-related pain is common after a traumatic injury; headache disorders are ranked as the third leading cause of disability worldwide.
Headache-related pain is common after a traumatic injury; headache disorders are ranked as the third leading cause of disability worldwide.

Posttraumatic stress disorder (PTSD) is a valuable predictor for headache-related disability among individuals who have experienced a traumatic physical injury, according to a prospective observational study published in Headache.

Investigators assessed single-incident traumatic physical injury survivors (n=80) for symptoms of PTSD and a composite of depression and anxiety symptoms (negative affect [NA]). Specifically, researchers evaluated NA as the primary predictor of 6-week subacute and 3-month chronic headache-related disability.

Analysis revealed NA to be a significant predictor for subacute (Cohen's ƒ2=0.130; P =.005) and chronic headache-related disability (Cohen's ƒ2=0.160; P =.004) in this cohort. 

The predictive value of NA extended beyond that of demographic and injury-related factors, including sex, headache history, and closed head injury. Additional evaluation demonstrated an even greater predictive value of PTSD for subacute (Cohen's ƒ2=0.105; P =.012) and chronic (Cohen's ƒ2=0.103; P =.022) headache-related disability, which extended beyond injury-related and demographic factors, anxiety, and depression.

The investigators of this study retrospectively measured preinjury headache frequency at 6 weeks postinjury; thus, these preinjury data may not have been exact. In addition, the researchers were unable to infer causal conclusions regarding headache-related disability because of the lack of preinjury headache-related disability scores or headache diagnoses at baseline.

Considering PTSD was found to be the best indicator for headache-related disability in physical traumatic injury survivors, the researchers suggest that early "screening for [PTSD] soon after trauma may more efficiently identify patients at risk than screening for all components of NA."

Reference

Pacella ML, Hruska B, George RL, Delahanty DL. The role of negative affect on headache-related disability following traumatic physical injury [published online November 28, 2017]. Headache. doi:10.1111/head.13233

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