Incidence and prognosis of post-traumatic headache in adults

Post-traumatic headache (PTH) is a common debilitating symptom after mild traumatic brain injury (MTBI) or concussion from motor vehicle collisions (MVC), falls, sports concussions and other trauma. It is also a common whiplash-associated disorder (WAD). PTH is one of the most poorly understood headache disorders in terms of its burden, pathophysiology, and prognosis. The primary objective of my thesis was to investigate the incidence and prognosis of PTH. To achieve this, I conducted a systematic review, and developed two prediction models by analyzing data from a population-based, incidence cohort study on traffic injuries from Saskatchewan, Canada. Finally, I used data from an insurance cohort of Swedish incident traffic injuries to validate my prediction models. My systematic review revealed sparse literature on the incidence and prognosis of PTH. The incidence of PTH varied across studies because the methods and populations studied were very different. The review suggested that pre-existing headache, younger age, and post-traumatic stress disorder (PTSD) are associated with delayed recovery from PTH. From my analysis of the Saskatchewan cohort, I found that the incidence of PTH is highest among young females, with an annual incidence of 734 per 100,000 (95% CI 731.5â 736.6) in 1999. I developed two separate prediction models for PTH and the nonrecovery from all injuries six months after a MVC. The models are based on patient and clinical characteristics that are routinely collected during an initial clinical encounter. Some common predictors between the models included older age, poorer current health, and lower recovery expectations. The predictive abilities were similar for both models (c-statistic: 0.73). The models were externally validated in a population of traffic-injured adults from Sweden. This thesis provides the first evidence synthesis on the incidence and prognosis of PTH. It also presents the first sex-, age-, and sex-age-stratified estimates of population-based incidence rates of PTH following MVC and proposes prediction models for recovery at six months in adults with PTH. This information advances the field of PTH by indicating important gaps in the literature, and providing recommendations for improving the prediction of outcomes for adults who present with PTH within 30 days of a traffic collision.Ph.D.2019-12-19 00:00:0