This preliminary study had two main objectives. Firstly, to find out the presence of generalized headache or localized headache at site of trauma at 2 hours of injury to head in GCS 15 patients and the possibility of having a serious head injury in patients having a significant generalized headache.
All the Patients above 16 years of age who presented to ED with a GCS of 15 at 2 hours of head injury without any previous neurology, not on any anticlotting agents were included into the study. Patients with significant other injuries were excluded. A pre-tested questionnaire was filled by the first contact medical officer at 2 hours of injury and patient was followed up again at 24hours of injury. The questionnaire included the age, gender, mechanism of injury, criteria for Canadian CT rule. The severity of headache was assessed using visual analogue. The study was conducted in a Teaching Hospital for a period of 1 month.
52 subjects were enrolled in the study in which 17(33%) were above 60 years of age. Altogether 16(30%) had CT brain and rest of the patients were sent for 24-hour head injury observation according to local protocol. Out of 16 who had CT, nearly 60% CT findings were normal. Rest of the 36 patients who sent for 24-hour observation except 2 patients who lost follow up, rest of them had no significant complain by 24 hours.
Out of 52 subjects 48 patients complained of either localized headache (29, 55%) or generalized headache (19, 36%). In which all the patients who ended up with positive CT brain complained of significant (more than 5 in visual analogue scale) generalized headache. All Patients who complained of only a localized pain at 2 hours of injury ended up with negative findings at 24 hours.
Significant generalized headache at 2 hours from head injury in GCS 15 patients should be concerned seriously and can be included in adult mTBI management protocols as a reliable clinical tool. Localized headache following mTBI without generalization is a good negative clinical finding.