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Pradhyumnan H, Perez GG, Patel SH, Blaya MO, Bramlett HM, Raval AP. A Perspective on Hormonal Contraception Usage in Central Nervous System Injury. J Neurotrauma 2024; 41:541-551. [PMID: 37975282 DOI: 10.1089/neu.2023.0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Naturally occurring life stages in women are associated with changes in the milieu of endogenous ovarian hormones. Women of childbearing age may be exposed to exogenous ovarian hormone(s) because of their use of varying combinations of estrogen and progesterone hormones-containing oral contraceptives (OC; also known as "the pill"). If women have central nervous system (CNS) injury such as spinal cord injury (SCI) and traumatic brain injury (TBI) during their childbearing age, they are likely to retain their reproductive capabilities and may use OC. Many deleterious side effects of long-term OC use have been reported, such as aberrant blood clotting and endothelial dysfunction that consequently increase the risk of myocardial infarction, venous thromboembolism, and ischemic brain injury. Although controversial, studies have suggested that OC use is associated with neuropsychiatric ramifications, including uncontrollable mood swings and poorer cognitive performance. Our understanding about how the combination of endogenous hormones and OC-conferred exogenous hormones affect outcomes after CNS injuries remains limited. Therefore, understanding the impact of OC use on CNS injury outcomes needs further investigation to reveal underlying mechanisms, promote reporting in clinical or epidemiological studies, and raise awareness of possible compounded consequences. The goal of the current review is to discuss the impacts of CNS injury on endogenous ovarian hormones and vice-versa, as well as the putative consequences of exogenous ovarian hormones (OC) on the CNS to identify potential gaps in our knowledge to consider for future laboratory, epidemiological, and clinical studies.
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Affiliation(s)
- Hari Pradhyumnan
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratory (CVDRL), Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Gina G Perez
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratory (CVDRL), Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Shahil H Patel
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratory (CVDRL), Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Meghan O Blaya
- Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
- The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Helen M Bramlett
- Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
- The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
- Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA
| | - Ami P Raval
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratory (CVDRL), Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
- Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA
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2
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Langer LK, Bayley MT, Lawrence DW, Comper P, Kam A, Tam A, Saverino C, Wiseman-Hakes C, Ruttan L, Chandra T, Foster E, Gladstone J. Revisiting the ICHD-3 criteria for headache attributed to mild traumatic injury to the head: Insights from the Toronto Concussion Study Analysis of Acute Headaches Following Concussion. Cephalalgia 2022; 42:1172-1183. [PMID: 35546269 PMCID: PMC9536000 DOI: 10.1177/03331024221099216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is limited prospective data on the prevalence, timing of onset, and characteristics of acute headache following concussion/mild traumatic brain injury. METHODS Adults diagnosed with concussion (arising from injuries not related to work or motor vehicle accidents) were recruited from emergency departments and seen within one week post injury wherein they completed questionnaires assessing demographic variables, pre-injury headache history, post-injury headache history, and the Sport Concussion Assessment Tool (SCAT-3) symptom checklist, the Sleep and Concussion Questionnaire (SCQ) and mood/anxiety on the Brief Symptom Inventory (BSI). RESULTS A total of 302 participants (59% female) were enrolled (mean age 33.6 years) and almost all (92%) endorsed post-traumatic headache (PTH) with 94% endorsing headache onset within 24 hours of injury. Headache location was not correlated with site of injury. Most participants (84%) experienced daily headache. Headache quality was pressure/squeezing in 69% and throbbing/pulsing type in 22%. Associated symptoms included: photophobia (74%), phonophobia (72%) and nausea (55%). SCAT-3 symptom scores, Brief Symptom Inventory and Sleep and Concussion Questionnaire scores were significantly higher in those endorsing acute PTH. No significant differences were found in week 1 acute PTH by sex, history of migraine, pre-injury headache frequency, anxiety, or depression, nor presence/absence of post-traumatic amnesia and self-reported loss of consciousness. CONCLUSIONS This study highlights the very high incidence of acute PTH following concussion, the timing of onset and characteristics of acute PTH, the associated psychological and sleep disturbances and notes that the current ICHD-3 criteria for headaches attributed to mild traumatic injury to the head are reasonable, the interval between injury and headache onset should not be extended beyond seven days and could, potentially, be shorted to allow for greater diagnostic precision.
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Affiliation(s)
- Laura Kathleen Langer
- KITE Research Institute at Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Mark Theodore Bayley
- KITE Research Institute at Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - David Wyndham Lawrence
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada.,Department of Family and Community Medicine, Mt Sinai Hospital, Toronto, Canada
| | - Paul Comper
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute and Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
| | - Alice Kam
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Alan Tam
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Cristina Saverino
- Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Catherine Wiseman-Hakes
- KITE Research Institute at Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Lesley Ruttan
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Graduate Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto, Canada
| | - Tharshini Chandra
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Evan Foster
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Jonathan Gladstone
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Pediatrics (Division of Neurology), Hospital for Sick Children, Toronto, Canada.,Gladstone Headache Clinic, Toronto, Canada
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3
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Begasse de Dhaem O, Robbins MS. Cognitive Impairment in Primary and Secondary Headache Disorders. Curr Pain Headache Rep 2022; 26:391-404. [PMID: 35239156 PMCID: PMC8891733 DOI: 10.1007/s11916-022-01039-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2022] [Indexed: 11/28/2022]
Abstract
Purpose of Review To critically evaluate the recent literature on cognitive impairment and headache. Recent Findings Neurocognitive symptoms are prevalent, debilitating, and occur often with both primary and secondary headache disorders. Summary This is a “narrative review of the current literature in PubMed on cognitive function and headache.” Migraine is associated with cognitive impairment years before a migraine diagnosis. In young and middle-aged adults, migraine is associated with deficits in attention, executive function, processing speed, and memory. It is unlikely that migraine is associated with dementia. Although methodologically difficult to assess, there does not seem to be an association between tension-type headache and cognitive dysfunction. In early to midlife, cluster headache seems to be associated with executive dysfunction. Several secondary headache syndromes relevant to clinicians managing headache disorders are associated with poorer cognitive performance or distinctive cognitive patterns, including those attributed to chronic cerebral or systemic vascular disorders, trauma, and derangements of intracranial pressure and volume, including frontotemporal brain sagging syndrome.
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Affiliation(s)
| | - Matthew S Robbins
- Department of Neurology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
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4
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A five-year clinical audit of concussive injuries in South African collegiate male rugby players—a South African experience. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-021-00768-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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5
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Bertolini G, Romano F, Straumann D, Keller K, Palla A, Feddermann-Demont N. Measuring optokinetic after-nystagmus: potential for detecting patients with signs of visual dependence following concussion. J Neurol 2021; 268:1747-1761. [PMID: 33367947 PMCID: PMC8068696 DOI: 10.1007/s00415-020-10359-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/20/2020] [Accepted: 12/04/2020] [Indexed: 12/27/2022]
Abstract
Concussed patients with chronic symptoms commonly report dizziness during exposure to environments with complex visual stimuli (e.g. supermarket aisles, busy crossroads). Such visual induced dizziness is well-known in patients with vestibular deficits, in whom it indicates an overreliance on visual cues in sensory integration. Considering that optokinetic after-nystagmus (OKAN) reflects the response of the central network integrating visual and vestibular self-motion signals (velocity storage network), we investigated OKAN in 71 patients [17 (23.9%) females, 30.36 ± 9.05 years old] who suffered from persistent symptoms after a concussion and presented clinical signs suggesting visual dependence. Data were retrospectively compared with 21 healthy individuals [13 (61.9%) females, 26.29 ± 10.00 years old]. The median values of the slow cumulative eye position and of the time constant of OKAN were significantly higher in patients than in healthy individuals (slow cumulative eye position: 124.15 ± 55.61° in patients and 77.87 ± 45.63° in healthy individuals-p = 0.012; time constant: 25.17 ± 10.27 s in patients and 13.95 ± 4.92 s in healthy individuals-p = 0.003). The receiving operating curve (ROC) estimated on the time constant had an overall area under the curve of 0.73. Analysis of the ROC suggests that a test measuring the OKAN time constant could obtain a sensitivity of 0.73 and specificity of 0.72 in determining the origin of the visual-related disturbances in those patients (threshold 16.6 s). In a subset of 43 patients who also performed the Sensory Organization Test (SOT), the proposed OKAN test was twice as sensitive as the SOT. This study suggests that concussed patients with persisting visual symptoms may have an underlying impairment of the velocity storage mechanism and that measuring the OKAN time constant can objectify such impairment.
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Affiliation(s)
- Giovanni Bertolini
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland.
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, CH-8091, Zurich, Switzerland.
- University of Zurich, Zurich, Switzerland.
- Clinical Neuroscience Center, Zurich, Switzerland.
| | - Fausto Romano
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, CH-8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, Zurich, Switzerland
| | - Dominik Straumann
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, CH-8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, Zurich, Switzerland
| | - Katharine Keller
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, CH-8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Antonella Palla
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
| | - Nina Feddermann-Demont
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, CH-8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, Zurich, Switzerland
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6
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Bressan S, Clarke CJ, Anderson V, Takagi M, Hearps SJC, Rausa V, Anderson N, Doyle M, Dunne K, Oakley E, Davis GA, Babl FE. Use of the sport concussion assessment tools in the emergency department to predict persistent post-concussive symptoms in children. J Paediatr Child Health 2020; 56:1249-1256. [PMID: 32436608 DOI: 10.1111/jpc.14910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 02/13/2020] [Accepted: 03/15/2020] [Indexed: 11/28/2022]
Abstract
AIM The Sport Concussion Assessment Tool v3 (SCAT3) and its child version (ChildSCAT3) are composite tools including a symptom scale, a rapid cognitive assessment (standardised assessment of concussion (SAC)) and the modified Balance Error Scoring System (mBESS). It is unclear whether their use for the acute assessment of paediatric concussion in the emergency department (ED) may help predict persistent post-concussive symptoms (PPCS). We aim to assess the predictive value of the main SCAT3/ChildSCAT3 components for PPCS when applied in the ED. METHODS A single-site, prospective longitudinal cohort study of children aged 5-18 years assessed within 48 h of their concussion at the ED of a state-wide tertiary paediatric hospital and followed up at the affiliated concussion clinic, between November 2013 and August 2017. PPCS was defined as ≥2 new or worsening symptoms at 1 month post-injury using the Post-Concussive Symptom Inventory. RESULTS Of the 370 children enrolled, 213 (57.7% <13 years old) provided complete data. Of these, 34.7% had PPCS at 1 month post-injury (38.2% of children <13 years and 30.0% ≥13 years of age, P = 0.272). The adjusted ORs from multiple logistic regression models, for number and severity of symptoms, and for the SAC and mBESS performance in both the ChildSCAT3/SCAT3, were all not significant. The area under the curve of receiver operator characteristic curves for all analysed ChildSCAT3/SCAT3 components was below 0.6. CONCLUSIONS Although SCAT3 and ChildSCAT3 are recommended tools to assist with concussion diagnosis and monitoring of patient recovery, their use in the ED does not seem to help predict PPCS.
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Affiliation(s)
- Silvia Bressan
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Cathriona J Clarke
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Psychology Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Takagi
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen J C Hearps
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vanessa Rausa
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Nicholas Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Melissa Doyle
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Kevin Dunne
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Rehabilitation Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Ed Oakley
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Gavin A Davis
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neurosurgery, Austin Health & Cabrini Hospital, Melbourne, Victoria, Australia
| | - Franz E Babl
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
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7
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Hannah T, Dreher N, Li AY, Shankar DS, Adams R, Gometz A, Lovell MR, Choudhri TF. Assessing the predictive value of primary evaluation with the Immediate Post-Concussion Assessment and Cognitive Test following head injury. J Neurosurg Pediatr 2020; 26:171-178. [PMID: 32384275 DOI: 10.3171/2020.2.peds19709] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/05/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Concussions are a major public health concern, especially for high school and college student athletes. However, there are few prognostic metrics that can accurately quantify concussion severity in order to anticipate recovery time and symptom regression. The Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) is a widely used neurocognitive assessment that can diagnose and track recovery from concussions. This study assesses whether initial ImPACT scores, collected within 48 hours of the injury, can predict persistence of concussion at follow-up. METHODS Results from 6912 ImPACT tests were compiled in 2161 unique student athletes, ages 12-22 years. The authors defined a novel metric, the Severity Index (SI), which is a summation of the number of standard deviations from baseline at the 80% CI for each of the 5 composite scores reported by ImPACT. Patients were binned into groups based on SI (0-3.99, 4-7.99, 8-11.99, 12+) and the relationships between SI groups, composite scores, symptom profiles, and recovery time were characterized using 1-way and 2-way ANOVAs and Kaplan-Meier plots. A logistic regression assessed the value of SI for predicting concussion at follow-up. RESULTS Patients with a higher SI at diagnosis were more likely to still be concussed at their first follow-up (F3,2300 = 93.06; p < 0.0001). Groups with a higher SI also displayed consistently slower recovery over a 42-day period and were more likely to report symptoms in all 4 symptom clusters (Migraine, Cognition, Sleep, and Neuropsychiatric). When controlling for sex, age, number of previous concussions, days between assessments, and location, SI significantly increased the odds of being concussed at follow-up (OR 1.122, 95% CI 1.088-1.142; p < 0.001). This model showed good discrimination with an area under the curve of 0.74. CONCLUSIONS SI is a useful prognostic tool for assessing head injury severity. Concussions with higher initial SI tend to last longer and have broader symptomatic profiles. These findings can help patients and providers estimate recovery based on similar ImPACT score profiles.
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Affiliation(s)
- Theodore Hannah
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York
| | - Nickolas Dreher
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York
| | - Adam Y Li
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York
| | - Dhruv S Shankar
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York
| | - Ryan Adams
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York
| | - Alex Gometz
- 2Physical Medicine and Rehabilitation, Concussion Management of New York, New York; and
| | - Mark R Lovell
- 3Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Tanvir F Choudhri
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York
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8
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Guglielmetti M, Serafini G, Amore M, Martelletti P. The Relation between Persistent Post-Traumatic Headache and PTSD: Similarities and Possible Differences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114024. [PMID: 32516965 PMCID: PMC7313050 DOI: 10.3390/ijerph17114024] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/11/2020] [Accepted: 05/26/2020] [Indexed: 12/27/2022]
Abstract
Post-traumatic headache (PTH) may be considered a secondary headache, which is linked to severe disability and psychosocial impairment. Interestingly, nearly 30% of subjects with persistent post-traumatic headache (PPTH) also suffer from post-traumatic stress disorder (PTSD). Although existing studies demonstrated the existence of common pathophysiological characteristics in subjects with migraine and PPTH, the differences and similarities between these complex diseases are currently poorly understood and are yet to be comprehensively elucidated. Thus, the present review aimed to systematically investigate the nature of PPTH in the effort to better identify both the neurobiological and clinical aspects underlying this condition. Overall, the included studies reported that: (1) the predictors for persistent acute traumatic injury to the head were female gender, persistent symptoms related to mild post-traumatic brain injury (mTBI), PTSD, elevated inflammatory markers, prior mild traumatic brain injury, being injured while suffering from alcohol abuse; (2) static/dynamic functional connectivity differences, white matter tract abnormalities, and morphology changes were found between PPTH and migraine in brain regions involved in pain processing; and (3) clinical differences which were most prominent at early time points when they were linked to the increased risk of PPTH. Based on the selected reports, the relation between migraine and PPTH needs to be considered bidirectionally, but PTSD may play a critical role in this relation. The main implications of these findings, with a specific focus on PTSD, are discussed. Further longitudinal studies are needed to reveal the exact nature of this relation, as well as to clarify the distinct clinical characteristics of migraine, PPTH, and PTSD.
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Affiliation(s)
- Martina Guglielmetti
- Sant’Andrea Hospital, Regional Referral Headache Centre, 00181 Rome, Italy; (M.G.); (P.M.)
- Department of Clinical and Molecular Medicine, Sapienza University, 00181 Rome, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics and Maternal Childhood Sciences, Psychiatry Unit, University of Genoa, 16132 Genoa, Italy;
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Correspondence: ; Tel.: +39-010-353-7668 (office); +39-347-537-2316 (mobile); Fax: +39-010-353-7669
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics and Maternal Childhood Sciences, Psychiatry Unit, University of Genoa, 16132 Genoa, Italy;
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Paolo Martelletti
- Sant’Andrea Hospital, Regional Referral Headache Centre, 00181 Rome, Italy; (M.G.); (P.M.)
- Department of Clinical and Molecular Medicine, Sapienza University, 00181 Rome, Italy
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9
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McConnell B, Duffield T, Hall T, Piantino J, Seitz D, Soden D, Williams C. Post-traumatic Headache After Pediatric Traumatic Brain Injury: Prevalence, Risk Factors, and Association With Neurocognitive Outcomes. J Child Neurol 2020; 35:63-70. [PMID: 31581879 PMCID: PMC7308075 DOI: 10.1177/0883073819876473] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Post-traumatic headache is common after pediatric traumatic brain injury and affects thousands of children every year, but little is known about how headache affects recovery after traumatic brain injury in other symptom domains. We aimed to determine the association between headache and other common symptoms after pediatric traumatic brain injury and explore whether subjective complaints of headache are associated with objective deficits on specialized neurocognitive testing. We conducted a retrospective cohort study of children ages 3-19 years following traumatic brain injury with a completed Sports Concussion Assessment Tool (SCAT) questionnaire. Post-traumatic headache was defined by a score more than 2 on the SCAT question for headache and define headache groups for comparison. In our cohort, we analyzed data from the Delis-Kaplan Executive Function System and the Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II). Headache was reported in 40 (33%) patients presenting for post-traumatic brain injury care among 121 pediatric traumatic brain injury patients and did not differ by injury severity. Median total SCAT symptom score in the headache group was 5-fold higher compared to patients without headache (median 45.5 vs 9; P < .001). Significantly lower-scaled scores in color naming, matrix reasoning, letter sequencing, and letter switching were also found in the headache group (all P ≤ .03). Our study shows that headache, as reported by patients on the SCAT, is associated with higher symptom scores in all other symptom domains, including sleep, mood, sensory, and cognitive. Headache was also associated with worse objective neurocognitive measures and may identify patients who could benefit from specialized follow-up care and management.
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Affiliation(s)
- Blake McConnell
- School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Tyler Duffield
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Trevor Hall
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Juan Piantino
- Division of Pediatric Neurology, Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Dylan Seitz
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Daniel Soden
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Cydni Williams
- Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
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10
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Lumba-Brown A, Teramoto M, Bloom OJ, Brody D, Chesnutt J, Clugston JR, Collins M, Gioia G, Kontos A, Lal A, Sills A, Ghajar J. Concussion Guidelines Step 2: Evidence for Subtype Classification. Neurosurgery 2020; 86:2-13. [PMID: 31432081 PMCID: PMC6911735 DOI: 10.1093/neuros/nyz332] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/23/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Concussion is a heterogeneous mild traumatic brain injury (mTBI) characterized by a variety of symptoms, clinical presentations, and recovery trajectories. By thematically classifying the most common concussive clinical presentations into concussion subtypes (cognitive, ocular-motor, headache/migraine, vestibular, and anxiety/mood) and associated conditions (cervical strain and sleep disturbance), we derive useful definitions amenable to future targeted treatments. OBJECTIVE To use evidence-based methodology to characterize the 5 concussion subtypes and 2 associated conditions and report their prevalence in acute concussion patients as compared to baseline or controls within 3 d of injury. METHODS A multidisciplinary expert workgroup was established to define the most common concussion subtypes and their associated conditions and select clinical questions related to prevalence and recovery. A literature search was conducted from January 1, 1990 to November 1, 2017. Two experts abstracted study characteristics and results independently for each article selected for inclusion. A third expert adjudicated disagreements. Separate meta-analyses were conducted to do the following: 1) examine the prevalence of each subtype/associated condition in concussion patients using a proportion, 2) assess subtype/associated conditions in concussion compared to baseline/uninjured controls using a prevalence ratio, and 3) compare the differences in symptom scores between concussion subtypes and uninjured/baseline controls using a standardized mean difference (SMD). RESULTS The most prevalent concussion subtypes for pediatric and adult populations were headache/migraine (0.52; 95% CI = 0.37, 0.67) and cognitive (0.40; 95% CI = 0.25, 0.55), respectively. In pediatric patients, the prevalence of the vestibular subtype was also high (0.50; 95% CI = 0.40, 0.60). Adult patients were 4.4, 2.9, and 1.7 times more likely to demonstrate cognitive, vestibular, and anxiety/mood subtypes, respectively, as compared with their controls (P < .05). Children and adults with concussion showed significantly more cognitive symptoms than their respective controls (SMD = 0.66 and 0.24; P < .001). Furthermore, ocular-motor in adult patients (SMD = 0.72; P < .001) and vestibular symptoms in both pediatric and adult patients (SMD = 0.18 and 0.36; P < .05) were significantly worse in concussion patients than in controls. CONCLUSION Five concussion subtypes with varying prevalence within 3 d following injury are commonly seen clinically and identifiable upon systematic literature review. Sleep disturbance, a concussion-associated condition, is also common. There was insufficient information available for analysis of cervical strain. A comprehensive acute concussion assessment defines and characterizes the injury and, therefore, should incorporate evaluations of all 5 subtypes and associated conditions.
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Affiliation(s)
- Angela Lumba-Brown
- Department of Emergency Medicine, Brain Performance Center, Stanford University, Stanford, California
| | - Masaru Teramoto
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah
| | - O Josh Bloom
- Carolina Sports Concussion Clinic, Cary, North Carolina
| | - David Brody
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - James Chesnutt
- Depts. of Family Medicine, Neurology, Orthopedics & Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - James R Clugston
- Departments of Community Health and Family Medicine and Neurology, University of Florida, Gainesville, Florida
| | - Michael Collins
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Gerard Gioia
- Division of Pediatric Neuropsychology, Safe Concussion Outcome Recovery & Education Program, Children's National Health System, Depts. of Pediatrics and Psychiatry & Behavioral Sciences, George Washington University School of Medicine, Rockville, Maryland
| | - Anthony Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Sports Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Avtar Lal
- Department of Neurosurgery, Concussion and Brain Performance Center, Stanford University, Stanford, California
| | - Allen Sills
- Department of Neurosurgery and Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jamshid Ghajar
- Department of Neurosurgery, Brain Performance Center, Stanford University, Stanford, California
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11
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Smirl JD, Jones KE, Copeland P, Khatra O, Taylor EH, Van Donkelaar P. Characterizing symptoms of traumatic brain injury in survivors of intimate partner violence. Brain Inj 2019; 33:1529-1538. [DOI: 10.1080/02699052.2019.1658129] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jonathan D. Smirl
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - K. Elisabeth Jones
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Paige Copeland
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Omeet Khatra
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edward H. Taylor
- School of Social Work, University of British Columbia, Kelowna, British Columbia, Canada
| | - Paul Van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
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12
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Affiliation(s)
- Vincent M Vacca
- Vincent M. Vacca, Jr., is adjunct faculty at Massachusetts College of Pharmacy and Health Sciences University in Boston, Mass
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13
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Nordhaug LH, Hagen K, Vik A, Stovner LJ, Follestad T, Pedersen T, Gravdahl GB, Linde M. Headache following head injury: a population-based longitudinal cohort study (HUNT). J Headache Pain 2018; 19:8. [PMID: 29356960 PMCID: PMC5777966 DOI: 10.1186/s10194-018-0838-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 01/12/2018] [Indexed: 12/15/2022] Open
Abstract
Background Headache is the most frequent symptom following head injury, but long-term follow-up of headache after head injury entails methodological challenges. In a population-based cohort study, we explored whether subjects hospitalized due to a head injury more often developed a new headache or experienced exacerbation of previously reported headache compared to the surrounding population. Methods This population-based historical cohort study included headache data from two large epidemiological surveys performed with an 11-year interval. This was linked with data from hospital records on exposure to head injury occurring between the health surveys. Participants in the surveys who had not been hospitalized because of a head injury comprised the control group. The head injuries were classified according to the Head Injury Severity Scale (HISS). Multinomial logistic regression was performed to investigate the association between head injury and new headache or exacerbation of pre-existing headache in a population with known pre-injury headache status, controlling for potential confounders. Results The exposed group consisted of 294 individuals and the control group of 25,662 individuals. In multivariate analyses, adjusting for age, sex, anxiety, depression, education level, smoking and alcohol use, mild head injury increased the risk of new onset headache suffering (OR 1.74, 95% CI 1.05–2.87), stable headache suffering (OR 1.70, 95% CI 1.15–2.50) and exacerbation of previously reported headache (OR 1.93, 95% CI 1.24–3.02). The reference category was participants without headache in both surveys. Conclusion Individuals hospitalized due to a head injury were more likely to have new onset and worsening of pre-existing headache and persistent headache, compared to the surrounding general population. The results support the entity of the ICHD-3 beta diagnosis “persistent headache attributed to traumatic injury to the head”.
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Affiliation(s)
- Lena Hoem Nordhaug
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway.
| | - Knut Hagen
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway.,Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, Trondheim, Norway
| | - Anne Vik
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway.,Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway
| | - Lars Jacob Stovner
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway.,Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, Trondheim, Norway
| | - Turid Follestad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torunn Pedersen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Gøril Bruvik Gravdahl
- Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, Trondheim, Norway
| | - Mattias Linde
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway.,Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, Trondheim, Norway
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14
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Baseline Properties of the Sport Concussion Assessment Tool 3 (SCAT3) in Iranian Professional League Football Players. Asian J Sports Med 2017. [DOI: 10.5812/asjsm.58076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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15
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Khazaei S, Hanis SM, Mansori K, Begasse de Dhaem O, Barr WB, Balcer LJ, Galetta SL, Minen MT. Correspondence regarding: Post-traumatic headache: the use of the sport concussion assessment tool (SCAT-3) as a predictor of post-concussion recovery. J Headache Pain 2017; 18:92. [PMID: 28861747 PMCID: PMC5578942 DOI: 10.1186/s10194-017-0795-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 08/04/2017] [Indexed: 12/17/2022] Open
Abstract
This article consists of a Letter to the Editor regarding Post-traumatic headache: the use of the sport concussion assessment tool (SCAT-3) as a predictor of post-concussion recovery, recently published in The Journal of Headache and Pain, along with a response from the original authors.
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Affiliation(s)
- Salman Khazaei
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shiva Mansouri Hanis
- School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kamyar Mansori
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran. .,Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
| | - Olivia Begasse de Dhaem
- Department of Internal Medicine, New York University Langone Medical Center, New York, USA.,Department of Neurology, Columbia University - New York Presbyterian Hospital, New York, USA
| | - William B Barr
- Department of Neurology, New York University Langone Medical Center, New York, USA
| | - Laura J Balcer
- Department of Neurology, New York University Langone Medical Center, New York, USA
| | - Steven L Galetta
- Department of Neurology, New York University Langone Medical Center, New York, USA
| | - Mia T Minen
- Department of Neurology, New York University Langone Medical Center, New York, USA
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