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Referral Gaps And Risk Factors For Long-term Headaches In Patients With Craniofacial Fractures
Bashar A. Hassan, MD, MPH1, Grishma Patel, BS
1, Eric Resnick, BS
1, Seray Er, BS
1, Jeison De Guzman, BS
1, Apanjit Sahi, BS
1, Nawal Shams, BS
1, Michael P. Grant, MD, PhD, FACS
1, Sashank K. Reddy, MD, PhD
2.
1Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA, 2Department of Plastic and Reconstructive Surgery, Johns Hopkins Medicine, Baltimore, MD, USA.
PURPOSE: Posttraumatic headache (PTH) affects up to 80% of patients with mild-to-moderate traumatic brain injury (TBI), contributing to significant morbidity and healthcare burden. While early diagnosis and treatment can help prevent persistent headaches, neurology referral rates remain low. This study aims to (1) identify risk factors for PTH persisting >1 year and (2) assess the frequency of neurology referrals in patients with craniofacial trauma.
METHODS: We retrospectively reviewed adult trauma patients who presented with frontal sinus, orbital, and mandibular fractures between (2018-2019). Our primary outcome was the frequency of persistent and new-onset PTH assessed >1 year of injury. Multivariable logistic regression was performed to identify risk factors for long-term PTH.
RESULTS: Among 622 patients with craniofacial fractures, 27% (n=166) presented with PTH, and 50% (310) exhibited signs or symptoms related to TBI. Despite this, 80% (n=248) of these patients were not referred to neurology/neurosurgery. Among 81 patients who were not referred and had follow-up >1 year, 12% (n=10) reported persistent or new-onset PTH. Among 229 patients with follow-up >1 year, 3.5% (n=8) developed new-onset migraines, and 14.4% (n=33) experienced persistent or new-onset PTH. Significant risk factors for persistent or new-onset PTH >1 year included a history of pre-trauma headaches (aOR [95% CI] 5 [2-15], P=0.004) and abnormal head CT findings on presentation (aOR [95% CI] 4 [1-14], P=0.03).
CONCLUSION: Patients with craniofacial fractures, particularly those with pre-trauma headaches and abnormal head CT findings on presentation, should be vigilantly monitored for PTH, and referred early to neurology to prevent long-term morbidity.
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