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Head or neck injury increases the risk of chronic daily headache

A population-based study

From the Department of Neurology (J.R.C.), University of Oklahoma Medical School, Oklahoma City; Department of Neurology, Epidemiology, and Population Health (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; Outcomes Research Institute (W.F.S.), Geisinger Health Systems, Danville, PA; and Department of Preventive Medicine and Biometrics (A.I.S.), Uniformed Services University, Bethesda, MD.

Address correspondence and reprint requests to Dr. James R. Couch, Department of Neurology, University of Oklahoma Medical School, 711 S.L. Young Blvd., Room 209, Oklahoma City, OK 73104

Objective: To evaluate the extent to which head and neck injury (HANI) contributes to chronic daily headache (CDH).

Background: In prospective studies, head injury is associated with headache (HA) that remains a problem at 12 to 24 months post-head injury in 20 to 30% of patients. Of these, up to 30 to 50% manifest CDH. The degree to which head injury contributes to CDH has not been evaluated in a non-clinical population. We evaluate the relationship between lifetime occurrence of HANI and CDH in a randomly chosen population sample.

Methods: Study participants are from the Frequent Headache Epidemiology Study. Cases with CDH (180 HA/year) and a comparison group with episodic headache (EH, 2 to 102 HA/year) were identified from the general population. Subjects were asked about lifetime occurrence of HANI. HANI were further classified as potentially precipitating injuries (PPI) if they occurred within 2 years of CDH onset for cases or in an equivalent 2-year period for EH controls.

Results: Lifetime occurrence of HANI was more frequent in cases than controls for men (adjusted OR = 3.1 [1.3 to 7.2]), women (OR = 1.5 [0.97 to 2.3]), and overall (OR = 1.7 [1.1 to 2.4]). The attributable risk was 15% (36% men, 11% women). Results were similar for PPI. The odds of CDH increased with the number of lifetime HANI in all groups (p < 0.05 trend).

Conclusions: Results suggest that head and neck injury (HANI) accounts for approximately 15% of chronic daily headache (CDH) cases in this non-clinical population. The relationship between HANI and CDH was not limited to injuries proximate to CDH onset. The lifetime risk of CDH increases with increasing number of HANI.

Abbreviations: AF = attributable (etiologic) fraction; CDH = Chronic daily headache; EH = episodic headache; FrHE = Frequent Headache Epidemiology Study; HA = headache; HANI = head and neck injury; ICDH-1 = International Classification of Headache Disorders; LOC = loss of consciousness; PPI = potentially precipitating injuries; TTH = tension-type headache; WIS - whiplash injury syndrome.

Supplemental data at www.neurology.org

Supported by GlaxoSmithKline, the Migraine Trust, and the American Headache Society. The funding sources had no control over study design, data collection and analysis, manuscript preparation, or decision to publish.

Disclosure: Drs. Couch, Lipton, and Stewart have all received research grants from GlaxoSmithKline in excess of $10,000. Drs. Couch and Lipton have received honoraria from GlaxoSmithKline in excess of $10,000. Dr. Scher received a grant in excess of $10,000 from GlaxoSmithKline for support of this study.

Received January 23, 2007. Accepted in final form April 13, 2007.

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