Utilizing the Biopsychosocial Model in Concussion Treatment: Post-Traumatic Headache and beyond

DOI: https://doi.org/10.1007/s11916- 020- 00870- y

Abstract-Summary To discuss recent literature concerning the application of the biopsychosocial model in the management of concussion and post-concussion headache.

Current research suggests that the biopsychosocial model is applicable to the concussion management process, particularly management of post-concussion headache.

The biopsychosocial model has significant applications to the management of

concussion, particularly post-concussion headache.

Extended: This review as a primer to spark such important future clinical and

research efforts.

Introduction This cascade is thought to underpin many of the acute and sub-acute signs and symptoms following concussion, including post-traumatic headache [97, 98].

Specific to headache, factors such as previous history of headache, family history of headache, medical history, and psychosocial history may impact the timing, severity, and chronicity of post-concussion headache [61, 99, 100].

The biopsychosocial approach is an established framework to provide guidance

in the assessment and management of concussion and post-traumatic headache.

The biopsychosocial model has been applied across various health conditions

with success at improving outcomes.

Some of the common areas where the model has been successfully applied include chronic pain [101, 102], spinal cord injury [103, 104], chronic pruritus [105], dementia [106], depression [107], and post-traumatic stress disorder [108].

Studies examining the interaction between biological, psychological, and social variables in low back pain management have demonstrated improved long-term out- comes [109, 110].

These studies provide a model for how the approach may be tailored to concus- sion assessment and management, as well as interventions and outcomes for consideration.

Concussion-Specific Applications of the Biopsychosocial Model Signs and symptoms are key assessment factors following concussion with head- ache, dizziness, and trouble concentrating being the most common symptoms fol- lowing injury [111].

It has been shown that patients diagnosed with a sports-related concussion and cervical spine dysfunction were found to exhibit higher Post-Concussion Symptom Scale (PCSS) scores, including headache [112].

Utilizing the biopsychosocial model during initial concussion assessment and recovery could help to identify individuals at risk for developing post-concussive

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5 Future Directions

syndrome (or chronic expression of symptoms) as perceived stress and pain have been shown to be predictors of chronic symptom expression as soon as 5 days post- injury [113].

When assessing headache specifically, the biopsychosocial model can fully

address the multidimensional expression symptoms and the needs of the patient.

Headache is a somatic symptom of concussion that is expressed differently post-

injury in each person and overlaps with other post-concussion symptoms.

Biopsychosocial Model Applications to Post-concussion Treatment Overall and to Post-traumatic Headache There are now many treatment options for both concussion and post-traumatic headache that can improve outcomes.

Informed by the biopsychosocial model, overall healthy behaviors have the

potential to aid post-traumatic headache symptoms following concussion.

Specific interventions that may improve outcomes for both concussion and head- ache include stress management, cognitive behavioral therapy (CBT), and social support interventions/programs.

CBT may be particularly helpful for individuals managing post-traumatic head- ache as negative/aversive thoughts associated with pain or mood deficits (i.e., depression, anxiety) from headache could be detrimental to overall concussion rehabilitation and those specifically tailored to this patient population have potential to help alleviate symptoms, increase rehabilitation efficacy, and program adher- ence [114].

Such interventions address (1) biological factors such as increasing cerebral blood flow (which may offset effects of concussion), (2) psychosocial factors such as a more rehabilitation-centered mindset, (3) mood improvements, (4) engagement in activity for individuals who are accustomed to being active, and (5) providing potential for social opportunities through their exercise and rehabilitation sessions [115, 116].

Conclusions The presentation and recovery following concussion is multifaceted and includes the continuum of biology, psychological, and social considerations.

Such efforts may represent an innovative future practice to fully incorporate par- ticular neurological and neuropsychological factors needing to be assessed and treated in this unique patient population.

In order to fully understand the widespread clinical utility and application of such models, there is a continued need for researcher, practitioner, and patient inte- gration and collaboration to determine the most effective assessment and treatment strategies when considering the dynamic nature of post-concussion presentation and management.

Acknowledgement A machine generated summary based on the work of Register-Mihalik, Johna K.; DeFreese, J. D.; Callahan, Christine E.; Carneiro, Kevin 2020 in Current Pain and Headache Reports.

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Post-concussion Syndrome

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Exploring naturally occurring clinical subgroups of post-traumatic headache