Abstract-Traumatic brain injury (TBI) is a common injury type among Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans, and headaches are a frequent consequence of TBI. We examined the hypothesis that among veterans who reported mild TBI caused by exposure to an explosion during deployment in OIF/OEF, those with residual neurocognitive deficits would have a higher frequency of headaches and more severe headaches. We evaluated 155 consecutive veterans with neurological examination and neuropsychological testing. We excluded 29 veterans because they did not have mild TBI or they did not complete the evaluation. We analyzed headache pattern, intensity, and frequency. Among the 126 veterans studied, 80 had impairments on neurological examination or neuropsychological testing that were best attributed to TBI. Veterans with impairments had been exposed to more explosions and were more likely to have headache, features of migraine, more severe pain, more frequent headaches, posttraumatic stress disorder, and impaired sleep with nightmares.

Abstract-This was an observational study of a cohort of 126 veterans with mild traumatic brain injury caused by an explosion during deployment in Operation Iraqi Freedom or Operation Enduring Freedom (OIF/OEF); 74 of the 126 veterans had comorbidities including frequent, severe headaches and residual deficits on neurological examination, neuropsychological testing, or both. Of these veterans, 71 had posttraumatic stress disorder and only 5 had restful sleep. We examined whether treatment with sleep hygiene counseling and oral prazosin would improve sleep, headaches, and cognitive performance. Nine weeks after providing sleep counseling and initiating an increasing dosage schedule of prazosin at bedtime, 65 veterans reported restful sleep. Peak headache pain (0-10 scale) decreased from 7.28 +/-0.27 to 4.08 +/-0.19 (values presented as mean +/-standard deviation). The number of headaches per month decreased from 12.40 +/-0.94 to 4.77 +/-0.34. Montreal Cognitive Assessment scores improved from 24.50 +/-0.49 to 28.60 +/-0.59. We found these gains maintained 6 months later. This pilot study suggests that addressing sleep is a good first step in treating posttraumatic headaches in OIF/OEF veterans.

BackgroundMild traumatic brain injury (mTBI) is a common injury among military personnel serving in Iraq or Afghanistan. The impact of repeated episodes of combat mTBI is unknown.ObjectiveTo evaluate relationships among mTBI, post-traumatic stress disorder (PTSD) and neurological deficits (NDs) in US veterans who served in Iraq or Afghanistan.MethodsThis was a case–control study. From 2091 veterans screened for traumatic brain injury, the authors studied 126 who sustained mTBI with one or more episodes of loss of consciousness (LOC) in combat. Comparison groups: 21 combat veterans who had definite or possible episodes of mTBI without LOC and 21 veterans who sustained mTBI with LOC as civilians.ResultsAmong combat veterans with mTBI, 52% had NDs, 66% had PTSD and 50% had PTSD and an ND. Impaired olfaction was the most common ND, found in 65 veterans. The prevalence of an ND or PTSD correlated with the number of mTBI exposures with LOC. The prevalence of an ND or PTSD was >90% for more than five episodes of LOC. Severity of PTSD and impairment of olfaction increased with number of LOC episodes. The prevalence of an ND for the 34 combat veterans with one episode of LOC (4/34=11.8%) was similar to that of the 21 veterans of similar age and educational background who sustained civilian mTBI with one episode of LOC (2/21=9.5%, p-NS).ConclusionsImpaired olfaction was the most frequently recognised ND. Repeated episodes of combat mTBI were associated with increased likelihood of PTSD and an ND. Combat setting may not increase the likelihood of an ND. Two possible connections between mTBI and PTSD are (1) that circumstances leading to combat mTBI likely involve severe psychological trauma and (2) that altered cerebral functioning following mTBI may increase the likelihood that a traumatic event results in PTSD.

Abstract-This was an observational study of a cohort of 63 Operation Iraqi Freedom/Operation Enduring Freedom veterans with mild traumatic brain injury (mTBI) associated with an explosion. They had headaches, residual neurological deficits (NDs) on neurological examination, and posttraumatic stress disorder (PTSD) and were seen on average 2.5 years after their last mTBI. We treated them with sleep hygiene counseling and oral prazosin. We monitored headache severity, daytime sleepiness using the Epworth Sleepiness Scale, cognitive performance using the Montreal Cognitive Assessment test, and the presence of NDs. We quantitatively measured olfaction and assessed PTSD severity using the PTSD Checklist-Military Version. Nine weeks after starting sleep counseling and bedtime prazosin, the veterans' headache severity decreased, cognitive function as assayed with a brief screening tool improved, and daytime sleepiness diminished. Six months after completing treatment, the veterans demonstrated additional improvement in headache severity and daytime sleepiness and their improvements in cognitive function persisted. There were no changes in the prevalence of NDs or olfaction scores. Clinical improvements correlated with reduced PTSD severity and daytime sleepiness. The data suggested that reduced clinical manifestations following mTBI correlated with PTSD severity and improvement in sleep, but not the presence of NDs or olfaction impairment.

Abstract-We determined whether the benefits of directed rehabilitation for pain, depression, and satisfaction with life persisted for veterans who were nonambulatory after spinal epidural metastasis (SEM) treatment. Twelve consecutive veterans (paraplegic after SEM treatment) who received 2 weeks of directed rehabilitation were compared with a historical control group of thirty paraplegic veterans who did not receive rehabilitation. Subjects were followed until death. Pain levels, depression, satisfaction with life, and consumption of pain medication were measured. Subjects who received rehabilitation had less pain, consumed less pain medication, were less depressed, and had higher satisfaction with life. The benefits to the rehabilitated subjects persisted until their deaths. We conclude that spinal cord injury rehabilitation for nonambulatory subjects with SEM produces persistent benefits for pain, depression, and satisfaction with life.