As a neuropsychiatrist who specializes in traumatic brain injury (TBI), Durga Roy applies a comprehensive, systematic approach to the diagnosis and management of neuropsychiatric symptoms in her patients. This involves coordinating and collaborating with other physicians in myriad specialties, including physical medicine and rehabilitation, neurology, neuropsychology, neurosurgery, pain management and internal medicine, to name a few. There is often a multimodal approach to treatment, which involves the need to integrate physical and occupational therapy in addition to speech-language pathology and psychotherapy.

Roy’s research focuses on examining diagnostic and prognostic markers of neuropsychiatric symptoms in the early TBI period and identifying which patients are at highest risk. The Head Injury Serum Markers in Response to Trauma (HeadSMART Study) — a longitudinal prospective cohort study that was born from a collaboration among the Johns Hopkins departments of emergency medicine, neuropsychiatry, neuropsychology, neurology and radiology at Johns Hopkins hospitals — studied systematic phenotyping to facilitate diagnosis and risk-stratification of the heterogenous group of patients diagnosed with TBI.

Roy and her team have published numerous manuscripts on findings from the HeadSMART database, with the most recent being a secondary data analysis examining the “Relationship Between Posttraumatic Headache and Depression After Mild Traumatic Brain Injury.”

Why TBI? Why headaches?
DR: Headaches are one of the most common physical symptoms after TBI: 30% of patients with mild TBI (mTBI) experience prolonged impairment.

What are the key findings?
DR: Acute posttraumatic headache (aPTH) and depressive symptoms were assessed with the Rivermead Post-Concussion Symptoms Questionnaire and the Patient Health Questionnaire-9 (PHQ-9), respectively, at one, three and six months of follow-up. Participants with aPTH within 24 hours after injury were more likely to report continued PTH after one month and to report more severe depressive symptoms at all follow-up time points.

This indicates that participants who reported aPTH within the first 24 hours after mTBI were at greater risk for developing depressive symptoms and moderate to severe depression compared with those who did not report a headache at the initial emergency room visit.

What are the clinical implications?
DR: At the time of presentation to the emergency room, the Rivermead and PHQ-9 scales could be used to screen individuals with aPTH and depressive symptoms, respectively. These results could be used to monitor symptom progression in the early TBI period.

What’s next?
DR: It is important to replicate findings beyond six months, because what we often see in our clinics are patients whose symptoms persist even up to or after a year. For the field to advance, it is important to invest in the growth of integrated care sites, psychosocial rehabilitation programs, early screening and early interventions, and treatment trials.