Prevalence of Headache Following Traumatic Brain Injury: A Systematic Review and Meta-Analysis.

Introduction: Post-traumatic headache (PTH) is a common and debilitating consequence of traumatic brain injury (TBI), significantly affecting patients' quality of life. It presents in various forms, including tension-type headaches and migraines, and is influenced by multiple neurological and psychological factors. Due to variability in diagnostic criteria across studies, the term "post-traumatic headache" in this review refers to headaches reported after TBI, not necessarily meeting full clinical diagnostic criteria. This study aims to systematically assess the prevalence of PTH to provide comprehensive data for improved clinical management and future research. Methods: This systematic review and meta-analysis followed PRISMA guidelines to assess PTH prevalence in TBI patients. A database search (2000-2024) identified eligible observational studies. Data extraction and quality assessment were conducted independently. Statistical analyses, including heterogeneity assessment, subgroup analysis, and meta-regression, were performed using Stata 17. Publication bias was examined via funnel plots and Egger's test. Results: The pooled prevalence of posttraumatic headache was 49.3% (95% CI: 44.7-53.9%), with sensitivity analysis confirming the stability of the findings. Subgroup analysis showed no significant difference in prevalence based on sample size or continent, though variations were observed across measurement tools, with interviews reporting the highest prevalence (65.2%) and the NRS the lowest (25.2%) (p < 0.001). Headache prevalence was higher in military populations (56.1%) than in the general patient group (45.1%) (p = 0.039). Meta-regression revealed that prevalence was not significantly influenced by publication year, sample size, or patient age, and no publication bias was detected. Conclusion: This meta-analysis confirms a high prevalence of post-traumatic headache, particularly among military populations and when assessed via interviews. Variations in prevalence were influenced by assessment methods and follow-up duration, but not by sample size or publication year. Despite methodological differences, the findings were stable, underscoring the need for standardized diagnostic criteria and targeted, population-specific management strategies.