Headache Pain Persists in Veterans With TBI

Persistent headaches occurred in nearly 98% of soldiers who suffered head trauma, blast exposure, or concussion while on duty in Iraq or Afghanistan, according to results of a survey of soldiers who returned from deployment between June and October 2008.

“Our goal was to try to determine the types, the duration, the frequency, and any occupational dysfunction caused by headaches in soldiers with a history of head trauma, concussion, or blasts,” Dr. Brett J. Theeler of the Madigan Army Medical Center in Tacoma, Wash., said in an interview.

Previous research has shown that about 15% of soldiers deployed to Iraq or Afghanistan experience mild traumatic brain injuries, but the prevalence and characteristics of the headaches associated with these injuries have not been well studied, he noted.

Dr. Theeler and his colleagues conducted a study based on a 13-item headache questionnaire. The study participants included 963 men and 15 women who returned from Iraq or Afghanistan within 3 months prior to enrolling in the study. The average age of the soldiers was 27 years.

The complete study results will be presented at the annual meeting of the American Academy of Neurology in April.

Overall, 351 of the 957 soldiers (37%) who reported headaches said that they started having headaches within a week of their injuries, and 20% reported that they started having headaches 1–4 weeks after their injuries.

Of those whose headaches began within 1 week of their injuries, 60% had headaches that met three or more criteria for migraines, and 40% said their headaches interfered with their normal activities. Of all of the soldiers who reported headaches, 30% said they had at least 15 days of headaches per month.

“We were very interested in the headache types,” Dr. Theeler said.

In an earlier study on headaches in soldiers, he and his colleagues found that more of these posttraumatic headaches had migraine features, compared with headaches in the general population (CLINICAL NEUROLOGY NEWS, Sept. 2006, p. 17). The current study had similar results.

“That doesn't mean that the head trauma or concussion is directly related to migraine, but we think head trauma is one of those important factors that lead these soldiers to have a higher frequency of migraines than people in the general population,” he said.

Identifying a specific type of headache might lead to a better diagnosis and possibly better treatments for the soldiers, Dr. Theeler said.

One of the take-home points for clinicians is that soldiers who have persistent migraine-type headaches might respond to migraine treatments, although the treatment of these soldiers has not been systematically studied, Dr. Theeler added.

Additional research is needed to determine the best acute medications and the best prophylactic treatments for soldiers who have headaches with migraine features after head trauma, and Dr. Theeler and his colleagues are currently conducting studies to address these issues.

Dr. Theeler said he had no financial conflicts to disclose.

Persistent headaches occurred in nearly 98% of soldiers who suffered head trauma, blast exposure, or concussion while on duty in Iraq or Afghanistan, according to results of a survey of soldiers who returned from deployment between June and October 2008.

“Our goal was to try to determine the types, the duration, the frequency, and any occupational dysfunction caused by headaches in soldiers with a history of head trauma, concussion, or blasts,” Dr. Brett J. Theeler of the Madigan Army Medical Center in Tacoma, Wash., said in an interview.

Previous research has shown that about 15% of soldiers deployed to Iraq or Afghanistan experience mild traumatic brain injuries, but the prevalence and characteristics of the headaches associated with these injuries have not been well studied, he noted.

Dr. Theeler and his colleagues conducted a study based on a 13-item headache questionnaire. The study participants included 963 men and 15 women who returned from Iraq or Afghanistan within 3 months prior to enrolling in the study. The average age of the soldiers was 27 years.

The complete study results will be presented at the annual meeting of the American Academy of Neurology in April.

Overall, 351 of the 957 soldiers (37%) who reported headaches said that they started having headaches within a week of their injuries, and 20% reported that they started having headaches 1–4 weeks after their injuries.

Of those whose headaches began within 1 week of their injuries, 60% had headaches that met three or more criteria for migraines, and 40% said their headaches interfered with their normal activities. Of all of the soldiers who reported headaches, 30% said they had at least 15 days of headaches per month.

“We were very interested in the headache types,” Dr. Theeler said.

In an earlier study on headaches in soldiers, he and his colleagues found that more of these posttraumatic headaches had migraine features, compared with headaches in the general population (CLINICAL NEUROLOGY NEWS, Sept. 2006, p. 17). The current study had similar results.

“That doesn't mean that the head trauma or concussion is directly related to migraine, but we think head trauma is one of those important factors that lead these soldiers to have a higher frequency of migraines than people in the general population,” he said.

Identifying a specific type of headache might lead to a better diagnosis and possibly better treatments for the soldiers, Dr. Theeler said.

One of the take-home points for clinicians is that soldiers who have persistent migraine-type headaches might respond to migraine treatments, although the treatment of these soldiers has not been systematically studied, Dr. Theeler added.

Additional research is needed to determine the best acute medications and the best prophylactic treatments for soldiers who have headaches with migraine features after head trauma, and Dr. Theeler and his colleagues are currently conducting studies to address these issues.

Dr. Theeler said he had no financial conflicts to disclose.

Persistent headaches occurred in nearly 98% of soldiers who suffered head trauma, blast exposure, or concussion while on duty in Iraq or Afghanistan, according to results of a survey of soldiers who returned from deployment between June and October 2008.

“Our goal was to try to determine the types, the duration, the frequency, and any occupational dysfunction caused by headaches in soldiers with a history of head trauma, concussion, or blasts,” Dr. Brett J. Theeler of the Madigan Army Medical Center in Tacoma, Wash., said in an interview.

Previous research has shown that about 15% of soldiers deployed to Iraq or Afghanistan experience mild traumatic brain injuries, but the prevalence and characteristics of the headaches associated with these injuries have not been well studied, he noted.

Dr. Theeler and his colleagues conducted a study based on a 13-item headache questionnaire. The study participants included 963 men and 15 women who returned from Iraq or Afghanistan within 3 months prior to enrolling in the study. The average age of the soldiers was 27 years.

The complete study results will be presented at the annual meeting of the American Academy of Neurology in April.

Overall, 351 of the 957 soldiers (37%) who reported headaches said that they started having headaches within a week of their injuries, and 20% reported that they started having headaches 1–4 weeks after their injuries.

Of those whose headaches began within 1 week of their injuries, 60% had headaches that met three or more criteria for migraines, and 40% said their headaches interfered with their normal activities. Of all of the soldiers who reported headaches, 30% said they had at least 15 days of headaches per month.

“We were very interested in the headache types,” Dr. Theeler said.

In an earlier study on headaches in soldiers, he and his colleagues found that more of these posttraumatic headaches had migraine features, compared with headaches in the general population (CLINICAL NEUROLOGY NEWS, Sept. 2006, p. 17). The current study had similar results.

“That doesn't mean that the head trauma or concussion is directly related to migraine, but we think head trauma is one of those important factors that lead these soldiers to have a higher frequency of migraines than people in the general population,” he said.

Identifying a specific type of headache might lead to a better diagnosis and possibly better treatments for the soldiers, Dr. Theeler said.

One of the take-home points for clinicians is that soldiers who have persistent migraine-type headaches might respond to migraine treatments, although the treatment of these soldiers has not been systematically studied, Dr. Theeler added.

Additional research is needed to determine the best acute medications and the best prophylactic treatments for soldiers who have headaches with migraine features after head trauma, and Dr. Theeler and his colleagues are currently conducting studies to address these issues.

Dr. Theeler said he had no financial conflicts to disclose.