Quality of Life With Posttraumatic and Naturally Occurring Headaches and Implications for Psychological Treatment

Abstract

The terms ‘head injury’ and ‘brain injury’ are used in the literature almost synonymously. The author uses the term ‘head injury’ for the purpose of this paper as it is commonly used in the literature and because injuries to the head include brain injuries. Head injuries due to accidents are a major health problem. The annual incidence of head injuries is said to be around 150 per 100,000 in the general population (British Society of Rehabilitation Medicine, 1998; Evans, 1992; Masson, Maurette, Salmi et al., 1996; McClelland, 1996). Santalucia and Feldmann (2000) reported the incidence to be between 175 to 367 per 100,000 population. Motor traffic accidents are the most frequent causes for head injury (42%). Further causes are falls (23%), assaults (14%) and sports injuries (6%) (Packard, 1999). Head injury often results in ‘a persisting constellation of subjective disabilities and complaints that have been termed the post-concussional syndrome’ (PCS) (Youngjohn, 1997). The aetiology of PCS has long been a controversy. On the one hand, symptoms are attributed to neurological dysfunctions and structural impairments (Radanov, 2001; Watson, Fenton, McClelland, Lumsden, Headley, Rutherford, 1995). On the other hand, it is understood that psychological factors play a larger role and have some interaction with physiological factors (Lishman, 1998 & 1988; Smith-Seemiller, Fow, Kant, Franzen, 2003). Between 51% and 86% of mild head injury patients suffer PCS (Powell, Collin, Sutton, 1996). The core symptoms are somatic (headache, vertigo, insomnia, visual disturbances, sensitivity to light and noise), affective (anxiety, irritability, depression) and cognitive (memory, attention, speed of information processing) (Smith-Seemiller et al., 2003). PCS persists for longer than three months in more than 60% of the cases, which means that patients experience long term disabilities (Masson et al., 1996; Powell et al., 1996; Rimel, Giordiani, Bacth et al., 1981).

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