Headache After Traumatic

Brain Injury: A National Survey

of Clinical Practices and
Treatment Approaches
Nama : Muslim jalil Perdana

Preseptor : dr. Nursanty, Sp.S

JOURNAL READING
•With this survey, we sought to gain an understanding of current practices and
perceptions among clinicians managing headache after TBI.
  Approval for exempt status was obtained from the University of
Washington Institutional Review Board.
 A 20-question survey of current clinical practice for classifying,
evaluating, and treating headache after TBI was developed by
the current investigators

 The survey was sent to all physicians who had enrolled in the Central
Nervous System Council of the American Academy of Physical Medicine
and Rehabilitation.

 This survey was sent electronically to these members, followed by 2

reminders to complete the survey sent biweekly.
• Only those respondents working in specialty headache clinics regularly reported use of
standardized headache-associated disability measures (eg, Headache Impact Test: HIT-6
[12], Migraine Disability Assessment Test: MIDAS [13]), and few respondents used a TBI
symptom checklist in their practices.
• TBI patients with objective neurologic impairments were more commonly seen in
specialty TBI and rehabilitation clinics, which implies that specialty headache and
neurology clinics tend to see more patients with mild TBI.
CDH was more likely to be noted by clinicians working in specialty headache clinics.
Migraine was the second most common headache type, noted primarily by clinicians
working in specialty headache or general neurology clinics. .
Headache Treatment

 were frequently used by all

respondents, although most often
used by clinicians practicing in
specialty headache clinics and least
frequently used by clinicians
practicing in specialty TBI clinics.
 Traditional physical therapy was the most frequently prescribed nonpharmacologic
treatment overall, though less common among respondents practicing in specialty TBI clinics.
• Survey respondents across all clinic types frequently view headache as a chronic
(more than 12 weeks post injury) problem (64%-89%).
•Practitioners noted frequent or very frequent association between post-traumatic
headache and new sleep disturbance (74%-86%), or new mood disturbance
(82%93%).
 Discussion

There were practice differences noted between neurologic and rehabilitation specialists.
Overall, neurologists tended to focus on pharmacologic treatment, whereas a musculoskeletal
and nonpharmacologic approach to management was taken by rehabilitation clinicians.

Migraine headache after TBI was more frequently reported by clinicians practicing in
specialty headache and general neurology clinics, and triptans were used more often
in these settings.
Tension-type headache was more frequently reported by specialty TBI (usually
physiatry) and general rehabilitation clinics, in which practitioners tended to
recommend aerobic exercise more often than other groups.
Not surprisingly, patients seen in headache specialty clinics appear to differ from those
seen in general neurology and rehabilitation-based clinics .
 TBI clinics or general rehabilitation clinics may be more likely to
care for patients with other associated somatic conditions.

 Focusing clinical attention on the presenting injuries that are most prominent and disabling,
and on those symptoms most likely to affect quality of life, reflecting this differencein TBI
populations served across clinic types.
 There may be a need for more education to providers who manage patients with headache
after TBI.
 A consistent and effective management approach using an established headache
classification system as well as valid functional, disability, and pain rating scales would lead to
more accurate diagnosis of headache type.
 Conclusion

These findings indicate that additional research is needed to determine the most
effective management strategies based on accurate headache typology.
They also identify an opportunity to bring together the spectrum of medical specialists
who treat individuals with headache after TBI in a collaborative effort to use established
headache diagnostic classification and measures of associated disability aspart of a
consistent, effective model of care.
TERIMA KASIH