Abstract
BACKGROUND: Previous publications have described the presence and severity of insomnia amongst those with persistent post-traumatic headache (PPTH), but there has been a paucity of studies investigating insomnia during the acute phase of post-traumatic headache (APTH). The primary study objective was to investigate insomnia symptoms and their severity in individuals with APTH due to mild traumatic brain injury (mTBI), and the secondary objective was to assess how psychological factors, sensory hypersensitivities, headache burden, and cognitive performance might associate with insomnia. METHODS: In this clinic-based, cross-sectional study, 82 individuals with APTH due to mTBI and 82 healthy controls (HC) were included. Participants completed the Insomnia Severity Index (ISI), Trail Making Test (TMT A and B), 12-item Allodynia Symptom Checklist (ASC-12), State-Trait Anxiety Inventory, Photosensitivity Assessment Questionnaire (PAQ), Beck Depression Inventory (BDI), Hyperacusis Questionnaire (HQ), Rey Auditory Verbal Learning Test (RAVLT), and a detailed headache characteristics questionnaire within 59 days of their mTBI to assess insomnia severity, psychological features, sensory hypersensitivities, headache symptoms, and cognitive performance. The questionnaire and test results were compared between APTH and HC groups. Within the APTH group, ISI scores were correlated with the other assessments to determine underlying clinical relationships. RESULTS: Participants with APTH, evaluated an average of 27.2 days after their mTBI, had significantly higher ISI scores (median [interquartile range, IQR] score 12 [6-17]) compared to HC (0 [1.3-6], p < 0.001). Twenty-four (29%) individuals with APTH had ISI scores categorized as moderate clinical insomnia compared to two (2%) in the HC group. Additionally, seven (9%) in the APTH group and none of the HC had ISI scores indicative of severe clinical insomnia. Those with APTH significantly differed from the HC on the BDI (median [IQR] score APTH: 9 [5-16.8] vs. HC: 2 [0-4]; p < 0.001), state anxiety (median [IQR] score APTH: 36.5 [26-45] vs. HC: 23 [20-27.5]; p < 0.001), trait anxiety (median [IQR] score APTH: 38 [27.3-46.8] vs. HC: 26 [23-30]; p < 0.001), photosensitivity (median [IQR] PAQ score APTH: 2 [1-4] vs. HC: 0 [0-1]; p < 0.001), allodynia (median [IQR] ASC-12 score APTH: 2 [0-5.8] vs. HC: 0 [0-0], p < 0.001), hyperacusis (median [IQR] HQ score APTH: 15.5 [7-23] vs. HC: 4 [2.3-7], p < 0.001), and RAVLT-delayed recall (median [IQR] score APTH: -0.8 [-1.5 to 0] vs. HC: -0.1 [-0.9 to 0.7], p = 0.019). For participants with APTH, the ISI was most significantly associated with the BDI (standardized regression coefficient (RC) [95% confidence interval, CI] 0.68 [0.52-0.84], p < 0.001), followed by state anxiety (RC [95% CI] 0.60 [0.42-0.78], p < 0.001), trait anxiety (RC [95% CI] 0.56 [0.37-0.74], p < 0.001), headache severity (RC [95% CI] 0.40 [0.19-0.60], p < 0.001), HQ (RC [95% CI] 0.36 [0.16-0.57], p = 0.001), and PAQ (RC [95% CI] 0.35 [0.15-0.56], p = 0.001). CONCLUSIONS: Individuals with APTH have more symptoms of insomnia compared to HC with 38% of individuals with APTH experiencing moderate or severe insomnia symptoms. Insomnia symptoms may be associated with more severe depression, anxiety, photophobia, hyperacusis, headache severity, and cognitive impairment. To address the overall well-being of patients with APTH, clinicians should screen for and appropriately manage insomnia along with other symptoms following mTBI.