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Headache After Traumatic Brain Injury: A National Survey of Clinical Practices and Treatment Approaches
Author(s) -
Brown Allen W.,
Watanabe Thomas K.,
Hoffman Jeanne M.,
Bell Kathleen R.,
Lucas Sylvia,
Dikmen Sureyya
Publication year - 2015
Publication title -
pmandr
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.617
H-Index - 66
eISSN - 1934-1563
pISSN - 1934-1482
DOI - 10.1016/j.pmrj.2014.06.016
Subject(s) - medicine , specialty , rehabilitation , physical therapy , traumatic brain injury , mood , neurology , clinical practice , family medicine , psychiatry
Background Individuals with headache after traumatic brain injury (TBI) receive care in a wide variety of clinical locations by physicians trained in multiple specialties. Objective To understand current practice patterns and perceptions of treatment issues among clinicians managing headache after TBI. Design National survey of current clinical practice using a 20‐item questionnaire developed by the authors. Participants Survey respondents were members of the Central Nervous System Council list survey of the American Academy of Physical Medicine and Rehabilitation (N = 1782) and the American Headache Society membership (N = 1260). Methods The survey was sent electronically to potential participants and was followed by 2 biweekly reminders. The survey queried the physicians' clinical setting; their use of headache classification systems, headache diaries, checklists, and diagnostic procedures; the pharmacologic and nonpharmacologic treatments prescribed; and headache chronicity and associated symptoms and disorders among their patients with TBI. Results Completed surveys were received from 193 respondents. The use of standardized classification systems and checklists was commonly reported. Respondents used nonpharmacologic and pharmacologic treatment approaches with similar frequency and modest perceived success rates. A high frequency of headache‐associated new sleep and mood disorders was reported. When response differences occurred between practice settings, they reflected a focus on headache diagnosis, classification, and pharmacologic treatment among neurology and specialty headache clinics, whereas a nonpharmacologic approach to management among TBI specialty and general rehabilitation clinicians was more commonly reported. Conclusion Management strategies for treating headache after TBI vary widely among general and specialty clinical practices. This suggests that additional research is needed that would lead to an increase in the use of established headache classification and the development of standardized management approaches so that all practitioners who care for patients after TBI can provide consistent effective care.