Association Between Headache Impact Test-6 Scores and The Severity of Insomnia in Patients With Post-Traumatic Headache

Vollständiger Abstract

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Background: Post-traumatic headache is common after traumatic brain injury and may stay beyond the early recovery period. Sleep disturbance, especially insomnia, also appears often after head trauma. These two problems may run together, yet the clinical link is still not always clear. HIT-6 gives a short estimate of headache impact, while ISI measures insomnia severity. This study examined whether higher headache impact is related to worse insomnia in patients with post-traumatic headache. Methods: This was an analytic observational study with a cross-sectional design. Patients with post-traumatic headache with trauma onset of 1-3 months were recruited consecutively from the neurology and neurosurgery outpatient setting at H. Adam Malik General Hospital Medan and network hospitals. Eligible patients were 18-60 years old, had post-traumatic headache, and agreed to participate. HIT-6 and ISI questionnaires were used. Demographic data and clinical history were collected from interview and medical records. Correlation analysis was done using Spearman test because the relevant variables were not normally distributed. Results: Forty-five patients were included. Median age was 41 years, range 23-57 years, and 26 patients were male. Most patients had mild traumatic brain injury based on GCS 13-15. ISI scores were 8-14 in 13 patients, 15-21 in 17 patients, and 22-28 in 15 patients. HIT-6 scores were <49 in 14 patients, 50-55 in 14 patients, 56-59 in 13 patients, and >60 in 4 patients. Trauma severity was not significantly related to ISI category or HIT-6 category. But HIT-6 score was strongly and positively related to insomnia severity, with p<0.001 and r=0.626. Conclusion: Higher headache impact was associated with more severe insomnia in patients with post-traumatic headache. This finding says headache burden and sleep should be assessed together after head trauma, not separately. The study cannot prove causality, but it gives a useful clinical signal.