TY - JOUR
T1 - Headache complexity (number of symptom features) differentiates post-traumatic from non-traumatic headaches
AU - Scher, Ann I.
AU - McGinley, James S.
AU - Wirth, R. J.
AU - Lipton, Richard B.
AU - Terrio, Heidi
AU - Brenner, Lisa A.
AU - Cole, Wesley R.
AU - Schwab, Karen
N1 - Funding Information:
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Primary funding for the study was provided by the Congressionally Directed Medical Research Programs. Additional support was provided by the Center for Neuroscience and Regenerative Medicine, Defense Medical Research and Development Program, the Defense and Veterans Brain Injury Center, and the Military Clinical Neuroscience Center of Excellence.
Funding Information:
The authors thank active duty service members for their service; the soldier?volunteers who collaborated in this study by donating their time across several waves of data collection; and key study personnel, including Jennifer Johnson, Donna Dennis, Dr Lonnie Nelson, Denise Strasser, Lisa Betthauser, Mary Alice Dale, and Gurvaneet Sahota. The views expressed in this article are those of the authors and do not necessarily reflect the official policy of the Uniformed Services University of the Health Sciences, the US Public Health Service, the United States Army, the Department of Health Affairs, or the Departments of Defense or Veterans Affairs, or the US Government. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Primary funding for the study was provided by the Congressionally Directed Medical Research Programs. Additional support was provided by the Center for Neuroscience and Regenerative Medicine, Defense Medical Research and Development Program, the Defense and Veterans Brain Injury Center, and the Military Clinical Neuroscience Center of Excellence.
Funding Information:
RBL is the Edwin S. Lowe Professor of Neurology at the Albert Einstein College of Medicine in New York. He receives research support from the NIH: 2PO1 AG003949 (multiple principal investigators), 5U10 NS077308 (principal investigator), R21 AG056920 (investigator), 1RF1 AG057531 (site principal investigator), RF1 AG054548 (investigator), 1RO1 AG048642 (investigator), R56 AG057548 (investigator), U01062370 (investigator), RO1 AG060933 (investigator), RO1 AG062622 (investigator), 1UG3FD006795 (multiple principal investigators), 1U24NS113847 (investigator), K23 NS09610 (mentor), K23AG049466 (mentor), K23 NS107643 (mentor). He also receives support from the Migraine Research Foundation and the National Headache Foundation. He serves on the editorial board of Neurology, as senior advisor to Headache, and associate editor to Cephalalgia. He has reviewed for the NIA and NINDS, holds stock options in eNeura Therapeutics and Biohaven Holdings; serves as consultant, advisory board member, or has received honoraria from: American Academy of Neurology, Allergan, American Headache Society, Amgen, Avanir, Biohaven, Biovision, Boston Scientific, Dr. Reddy’s (Promius), Electrocore, Eli Lilly, eNeura Therapeutics, Equinox, GlaxoSmithKline, Lundbeck (Alder), Merck, Pernix, Pfizer, Supernus, Teva, Trigemina, Vector, and Vedanta. He receives royalties from Wolff’s Headache 7 and 8 Edition, Oxford University Press, 2009, Wiley and Informa. th th
Funding Information:
JSM has received funding, research support, salary, or other compensation from Vector Psychometric Group LLC (employment), the American Headache Society (speaking and teaching), Amgen, Inc. (research support), Cephalalgia (Biostatistics Editor), National Headache Foundation (research support).
Publisher Copyright:
© International Headache Society 2020.
PY - 2021/4
Y1 - 2021/4
N2 - Background: Post-traumatic headaches are a common sequela of mild traumatic brain injury (concussion). It is unclear whether or how these headaches differ phenotypically from primary headaches. Objective: Determine whether there is an overarching unobserved latent trait that drives the expression of observed features of post-traumatic headache and other headaches. Methods: Data from this post-hoc analysis come from the Warrior Strong Cohort Study conducted from 2010 through 2015. Approximately 25,000 soldiers were screened for concussion history at routine post-deployment health assessments. A random sample was invited to participate, enrolling 1567. Twelve observed headache phenotypic features were used to measure “headache complexity”, the latent trait of clinical interest, using single factor confirmatory factor analysis. We compared headache complexity between groups and determined whether headache complexity predicted accessing medical care for headache. Results: Of 1094 soldiers with headaches, 198 were classified as having post-traumatic headache. These headaches were compared to those in the other soldiers (647 without concussion history and 249 with concussion history). Soldiers with post-traumatic headache had greater endorsement of all 12 headache features compared to the soldiers with non-concussive headaches. The confirmatory factor analysis showed good model fit (χ2 (51) = 95.59, p = 0.0002, RMSEA = 0.03, comparative fit index = 0.99, and Tucker-Lewis index = 0.99), providing empirical support for the headache complexity construct. Soldier groups differed in their mean headache complexity level (p < 0.001) such that post-traumatic headache soldiers had greater headache complexity compared to non-concussed soldiers (standardized mean difference = 0.91, 95% confidence interval: 0.72–1.09, p < 0.001 and to concussed soldiers with coincidental headaches standardized mean difference = 0.75, 95% confidence interval: 0.53–0.96, p < 0.001). Increasing headache complexity predicted medical encounters for headache (odds ratio = 1.87, 95% confidence interval: 1.49–2.35, p < 0.001) and migraine (odds ratio = 3.74, 95% confidence interval: 2.33–5.98, p < 0.001) during the year following deployment. Conclusions and relevance: The current study provided support for a single latent trait, characterized by observed headache symptoms, that differentiates between concussive and non-concussive headaches and predicts use of medical care for headache. The single trait confirmatory factor analysis suggests that post-traumatic headaches differ from non-concussive headaches by severity more than kind, based on the symptoms assessed. ClinicalTrials.gov identifier NCT01847040
AB - Background: Post-traumatic headaches are a common sequela of mild traumatic brain injury (concussion). It is unclear whether or how these headaches differ phenotypically from primary headaches. Objective: Determine whether there is an overarching unobserved latent trait that drives the expression of observed features of post-traumatic headache and other headaches. Methods: Data from this post-hoc analysis come from the Warrior Strong Cohort Study conducted from 2010 through 2015. Approximately 25,000 soldiers were screened for concussion history at routine post-deployment health assessments. A random sample was invited to participate, enrolling 1567. Twelve observed headache phenotypic features were used to measure “headache complexity”, the latent trait of clinical interest, using single factor confirmatory factor analysis. We compared headache complexity between groups and determined whether headache complexity predicted accessing medical care for headache. Results: Of 1094 soldiers with headaches, 198 were classified as having post-traumatic headache. These headaches were compared to those in the other soldiers (647 without concussion history and 249 with concussion history). Soldiers with post-traumatic headache had greater endorsement of all 12 headache features compared to the soldiers with non-concussive headaches. The confirmatory factor analysis showed good model fit (χ2 (51) = 95.59, p = 0.0002, RMSEA = 0.03, comparative fit index = 0.99, and Tucker-Lewis index = 0.99), providing empirical support for the headache complexity construct. Soldier groups differed in their mean headache complexity level (p < 0.001) such that post-traumatic headache soldiers had greater headache complexity compared to non-concussed soldiers (standardized mean difference = 0.91, 95% confidence interval: 0.72–1.09, p < 0.001 and to concussed soldiers with coincidental headaches standardized mean difference = 0.75, 95% confidence interval: 0.53–0.96, p < 0.001). Increasing headache complexity predicted medical encounters for headache (odds ratio = 1.87, 95% confidence interval: 1.49–2.35, p < 0.001) and migraine (odds ratio = 3.74, 95% confidence interval: 2.33–5.98, p < 0.001) during the year following deployment. Conclusions and relevance: The current study provided support for a single latent trait, characterized by observed headache symptoms, that differentiates between concussive and non-concussive headaches and predicts use of medical care for headache. The single trait confirmatory factor analysis suggests that post-traumatic headaches differ from non-concussive headaches by severity more than kind, based on the symptoms assessed. ClinicalTrials.gov identifier NCT01847040
KW - Concussion
KW - cohort study
KW - epidemiology
KW - post-traumatic headache
KW - traumatic brain injury
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U2 - 10.1177/0333102420974352
DO - 10.1177/0333102420974352
M3 - Article
C2 - 33242991
AN - SCOPUS:85096844824
SN - 0333-1024
VL - 41
SP - 582
EP - 592
JO - Cephalalgia
JF - Cephalalgia
IS - 5
ER -