Life quality, depression and anxiety symptoms in chronic post-traumatic headache after mild brain injury

Martins, Hugo André de Lima; Martins, Bianca Bastos Mazullo; Ribas, Valdenilson Ribeiro; Bernardino, Silvya Nery; Oliveira, Daniella Araújo de; Silva, Louana Cassiano; Sougey, Everton Botelho; Valença, Marcelo Moraes

doi:10.1590/S1980-57642012DN06010009

ABSTRACT

Post-traumatic headache (PTH) is the most common symptom found in the post-traumatic syndrome, whose onset occurs within seven days of the trauma. The condition is characterized as acute when it persists for up to 3 months. PTH beyond this period is considered chronic.

Objectives:

The objective of this study was to determine the clinical features of chronic post-traumatic headache (cPTH) and its association with depression, anxiety and quality of life.

Methods:

A total of 73 female subjects were evaluated. Patients were divided into three groups: (a) group without headache, CONTROL, n=25; (b) cPTH group, n=19; and (c) MIGRAINE, n=29, with all subjects in the 11-84 year age group. Symptoms of anxiety and depression were evaluated by the Beck inventories of anxiety and depression, and quality of life assessed by the Lipp and Rocha quality of life inventory. Qualitative variables were analyzed using the Chi-square or Fisher's exact tests and expressed as percentages whereas quantitative variables were analyzed by ANOVA, Mann-Whitney or Kruskal-Wallis tests with data expressed as mean±standard deviation, p<0.05.

Results:

Subjects with cPTH presented with headache manifesting similar features to those found in migraine. The cPTH group was associated with similar levels of anxiety and depression to the migraine group and higher than the CONTROL (p<0.001). Quality of life of individuals with cPTH was similar to that of subjects with migraine and lower than CONTROL subjects (p<0.05).

Conclusions:

cPTH presents similar clinical characteristics to migraine. Subjects with cPTH had high levels of anxiety and depression symptoms and reduced quality of life.

Key words:
headache; depression; anxiety; post-traumatic headache

RESUMO

A cefaleia é o sintoma mais encontrado na síndrome pós-traumática, iniciando-se dentro de sete dias após o trauma. Sua a forma aguda dura até três meses e a crônica persiste após este período.

Objetivos:

O objetivo deste estudo foi determinar as características clínicas da cefaleia pós-traumática crônica (CPTc) e sua associação com a depressão, ansiedade e com nível de qualidade de vida.

Métodos:

Foram avaliados 73 sujeitos do gênero feminino, divididos em três grupos: (a) grupo sem cefaleia (CONTROLE, n=25), (b) grupo com CPTc (n=19) e (c) migrânea (MIGRÂNEA, n=29), com idades variando entre 11 e 84 anos. Os sintomas de ansiedade e depressão foram avaliados pelos inventários de ansiedade e depressão de Beck e a qualidade de vida pelo inventário de qualidade de vida de Lipp e Rocha. As variáveis qualitativas foram analisadas pelos testes qui-quadrado ou exato de Fisher e expressas em percentuais e as quantitativas por ANOVA, Mann-Whitney ou Kruskal-Wallis com os dados apresentados em média±desvio padrão, p<0,05.

Resultados:

Os sujeitos com CPTc apresentaram cefaleia com características semelhantes as encontradas na migrânea. A CPTc esteve associada aos níveis de sintomas de ansiedade e depressão similares ao grupo com migrânea e superior ao CONTROLE (p<0,001). Os níveis de qualidade de vida dos sujeitos com CPTc mostraram-se semelhantes aos dos sujeitos com migrânea e inferior ao CONTROLE (p<0,05).

Conclusões:

A CPTc apresenta características clínicas semelhantes a migrânea. Os sujeitos com CPTc apresentam elevado nível de sintomas de ansiedade e depressão e nível de qualidade de vida reduzida.

Palavras-chave:
cefaleia; depressão; ansiedade; cefaleia pós-traumática

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REFERENCES

Gladstone J. From psychoneurosis to ICHD-II: an overview of the state of the art in posttraumatic headache. Headache 2009;49:1097-1111.
Souza CAC. Neuropsiquiatria dos traumatismos cranioencefálicos. Rio de Janeiro, Revinter; 2003:2:10.
Branca B, Giordani B, Lutz T, Saper JR. Self report of cognition and objective test performance in posttraumatic headache. Headache 1996;36:300-306.
Headache Classification Subcommittee of the International Headache Society. Classification and WHO ICD-10NA codes. Cephalalgia 2004; 24:6-22.
Packard RC. Posttraumatic headache: permanency and relationship to legal settlement. Headache 1992;32:496-500.
Ham LP, Andrasik F, Packard RC, Bundrick CM. Psychopathology in individuals with posttraumatic headaches and other pain types. Cephalalgia 1994;14:118-126.
Tatrow K, Blanchard EB, Hickling EJ, Silverman DJ. Posttraumatic headache: Biopsychosocial comparisons with multiple control groups. Headache 2003;43:755-766.
Gimse R, Bjorgem IA, Tjell C, Tyssedal JS, Bo K. Reduced cognitive function in a group of whiplash patients with demonstrated disturbances in the posture control system. J Clin Exp Neuropsychol 1997;19: 838-849.
Fioravanti M, Ramelli L, Napoleoni A. Posttraumatic headache: neuropsychological and clinical aspects. Cephalalgia 1983;3:221-224.
Gfeller JD, Chibnall JT, Duckro PN. Postconcussion symtoms and cognitive functioning in posttraumatic headache patients. Headache 1994;34:503-507.
Sougey EB, Castro RM. Depressão: repercussão no sistema serotoninérgico. Neurobiologia 1998;61:43-70.
Martins HAL, Ribas VR, Martins BBM, Ribas RMG, Valença MM. Posttraumatic headache. Arq Neuropsiquiatr 2009;67:43-45.
Valença MM, Medeiros FL, Martins HAL, Massaud RM, Peres MFP. Neuroendocrine dysfunction in fibromyalgia and migraine. Curr Pain Headache Rep 2009;13:358-64.
Gilkey SJ, Ramadan NM, Taruna K, Welch KMA. Cerebral blood flow in chronic posttraumatic headache. Headache 1997;37:583-587.
Packard RC. Treatment of chronic daily posttraumatic headache with divalproex sodium. Headache 2000;40:736-739.
Devi EN. Prevalence of chronic pain after traumatic brain injury: a systematic review. JAMA 2008;300:711-719.
Seifert TD, Evans RW. Posttraumatic headache: a review. Curr Pain Headache Rep 2010;14: 292-298.
Walker AE. Chronic posttraumatic headache. Headache 1965;5:67-72.
Dawn AM. Disability and chronic posttraumatic headache. Headache 2003;43:117-121.
Rimel RW, Giordani B, Barth JT, Boll TJ, Jane JA. Disability caused by minor head injury. Neurosurgery 1981;9:221-228.
Barnat MR. Post-traumatic headache patients: I. Demographics, injuries, headache and health status. Headache 1986;26:271-277.
Busch AM, Heinrich S, Thomas S, et al. Quality of life in adolescents with headache: Results from a population-based survey. Cephalalgia 2010;30:713-721.
Bigal ME, Fernandes LC, Moraes FA, Bordini CA, Speciali JG. Prevalência e impacto da migrânea em funcionários do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP. Arq Neuropsiquiatr 2000;58:431-436.
Packard RC, Ham LP. Impairment Ratings for Posttraumatic headache. Headache 1993;33:359-364.
Duckro PN, Chibnall JT, Tomazic TJ. Anger, depression, and disability: A path analysis of relationships in a sample of chronic posttraumatic headache patients. Headache 1995;35:35-395.
Galego JCB, Cipullo JP, Cordeiro JA, Tognol WA. Depression and migraine. Arq Neuropsiquiatr 2004;62:774-777.

1
Study conducted in the postgraduate degree in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco (UFPE), Recife PE, Brazil

Publication Dates

Publication in this collection
Jan-Mar 2012

History

Received
23 Sept 2011
Accepted
10 Dec 2011

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Gladstone J. From psychoneurosis to ICHD-II: an overview of the state of the art in posttraumatic headache. Headache 2009;49:1097-1111.

[2] Souza CAC. Neuropsiquiatria dos traumatismos cranioencefálicos. Rio de Janeiro, Revinter; 2003:2:10.

[3] Branca B, Giordani B, Lutz T, Saper JR. Self report of cognition and objective test performance in posttraumatic headache. Headache 1996;36:300-306.

[4] Headache Classification Subcommittee of the International Headache Society. Classification and WHO ICD-10NA codes. Cephalalgia 2004; 24:6-22.

[5] Packard RC. Posttraumatic headache: permanency and relationship to legal settlement. Headache 1992;32:496-500.

[6] Ham LP, Andrasik F, Packard RC, Bundrick CM. Psychopathology in individuals with posttraumatic headaches and other pain types. Cephalalgia 1994;14:118-126.

[7] Tatrow K, Blanchard EB, Hickling EJ, Silverman DJ. Posttraumatic headache: Biopsychosocial comparisons with multiple control groups. Headache 2003;43:755-766.

[8] Gimse R, Bjorgem IA, Tjell C, Tyssedal JS, Bo K. Reduced cognitive function in a group of whiplash patients with demonstrated disturbances in the posture control system. J Clin Exp Neuropsychol 1997;19: 838-849.

[9] Fioravanti M, Ramelli L, Napoleoni A. Posttraumatic headache: neuropsychological and clinical aspects. Cephalalgia 1983;3:221-224.

[10] Gfeller JD, Chibnall JT, Duckro PN. Postconcussion symtoms and cognitive functioning in posttraumatic headache patients. Headache 1994;34:503-507.

[11] Sougey EB, Castro RM. Depressão: repercussão no sistema serotoninérgico. Neurobiologia 1998;61:43-70.

[12] Martins HAL, Ribas VR, Martins BBM, Ribas RMG, Valença MM. Posttraumatic headache. Arq Neuropsiquiatr 2009;67:43-45.

[13] Valença MM, Medeiros FL, Martins HAL, Massaud RM, Peres MFP. Neuroendocrine dysfunction in fibromyalgia and migraine. Curr Pain Headache Rep 2009;13:358-64.

[14] Gilkey SJ, Ramadan NM, Taruna K, Welch KMA. Cerebral blood flow in chronic posttraumatic headache. Headache 1997;37:583-587.

[15] Packard RC. Treatment of chronic daily posttraumatic headache with divalproex sodium. Headache 2000;40:736-739.

[16] Devi EN. Prevalence of chronic pain after traumatic brain injury: a systematic review. JAMA 2008;300:711-719.

[17] Seifert TD, Evans RW. Posttraumatic headache: a review. Curr Pain Headache Rep 2010;14: 292-298.

[18] Walker AE. Chronic posttraumatic headache. Headache 1965;5:67-72.

[19] Dawn AM. Disability and chronic posttraumatic headache. Headache 2003;43:117-121.

[20] Rimel RW, Giordani B, Barth JT, Boll TJ, Jane JA. Disability caused by minor head injury. Neurosurgery 1981;9:221-228.

[21] Barnat MR. Post-traumatic headache patients: I. Demographics, injuries, headache and health status. Headache 1986;26:271-277.

[22] Busch AM, Heinrich S, Thomas S, et al. Quality of life in adolescents with headache: Results from a population-based survey. Cephalalgia 2010;30:713-721.

[23] Bigal ME, Fernandes LC, Moraes FA, Bordini CA, Speciali JG. Prevalência e impacto da migrânea em funcionários do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP. Arq Neuropsiquiatr 2000;58:431-436.

[24] Packard RC, Ham LP. Impairment Ratings for Posttraumatic headache. Headache 1993;33:359-364.

[25] Duckro PN, Chibnall JT, Tomazic TJ. Anger, depression, and disability: A path analysis of relationships in a sample of chronic posttraumatic headache patients. Headache 1995;35:35-395.

[26] Galego JCB, Cipullo JP, Cordeiro JA, Tognol WA. Depression and migraine. Arq Neuropsiquiatr 2004;62:774-777.

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