Clinical Review and Epidemiology of Headache Disorders in US Service Members: With Emphasis on Post‐traumatic Headache

Neely, Edward T.; Midgette, Lynn A.; Scher, Ann I.

doi:10.1111/j.1526-4610.2009.001460.x

Cited by 25 publications

(25 citation statements)

References 19 publications

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“…Of those without acute posttraumatic headache, 25% developed delayed onset of CDH. The study does point out the difficulty of identifying those with posttraumatic CDH as a group [17,Class III]. In a study from the civilian population, Couch and Bearss [18,Class III] found that less severe head injury was more likely to lead to CDH, although there is controversy on this point.…”

Section: Clinical Aspectsmentioning

confidence: 97%

“…Recent articles dealing with chronic headache in soldiers returning from deployment to war zones in Iraq and Afghanistan have suggested that the prevalence of posttraumatic headache attributed to mild head injury is as high as 37% [15][16][17]Class III]. In a recent study, 5,270 soldiers were screened for mild traumatic brain injury at a post-deployment evaluation; 1,033 (19.6%) met criteria for concussion, and 98% of these had headaches at the time of screening.…”

Section: Clinical Aspectsmentioning

confidence: 99%

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Update on Chronic Daily Headache

Couch

2010

Curr Treat Options Neurol

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Chronic daily headache (CDH), defined as a primary headache occurring at least 15 days per month, is a problem of worldwide scope, which is seen in 3% to 5% of the population. Though it has been recognized since ancient times, only recently have there been attempts to define and classify it. CDH usually consists of a mixture of migraine and tension-type headaches (TTH), with the more severe headaches having migraine features and the less severe headaches fitting the definition of TTH. Some patients have pure chronic TTH and no migrainous features, and others have only migraine, but most have a mixed migraine-TTH pattern. New daily persistent headache, a CDH pattern that comes on over a few days, constitutes 9% to 10% of this group and is otherwise indistinguishable from CDH. Hemicrania continua (1% of CDH) appears to be unique in being absolutely responsive to indomethacin. Accurate diagnosis of CDH is critical to management, as all organic etiologies of chronic headache must be ruled out. Problems often associated with CDH and complicating the diagnosis are head injury or medication overuse (rebound-withdrawal headache). These accompanying issues must be recognized and treated appropriately in the management plan. Finally, psychiatric problems (unipolar depression, bipolar disease, generalized anxiety disorder, and obsessive/compulsive disorder) often accompany CDH, as they are comorbid with migraine. These conditions must be recognized and treated along with the headache itself for treatment to succeed fully. Treatment of CDH is multimodal. The cornerstone of therapy is the use of prophylactic antimigraine medications to prevent or modulate the next headache. Amitriptyline, topiramate, valproic acid, and gabapentin have all had class I studies showing effectiveness in reducing headache occurrence. Recent studies with botulinum toxin have also shown effectiveness in reducing the headache burden. Recognition and treatment of medication overuse headache (MOH) must be carried out as part of the initial approach. Use of acute symptomatic treatments such as triptans or NSAIDs must be undertaken with care, as frequent use of these agents can lead to MOH. Educating the patient about the condition and reasonable expectations for therapy is essential to success. Recognition and appropriate treatment of psychiatric disorders is likewise essential. Adjunctive nondrug therapies and lifestyle changes round out the requirements for a management plan. The chances for long-term remission or significant improvement are up to 65%. The patient and physician must understand that CDH is a long-term process with relapses and remissions. A strong and trusting relationship between patient and physician is a major asset in managing this condition.

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Section: Clinical Aspectsmentioning

confidence: 97%

Section: Clinical Aspectsmentioning

confidence: 99%

Update on Chronic Daily Headache

Couch

2010

Curr Treat Options Neurol

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“…A smaller study of returning Iraq and Afghanistan veterans did use International Classification of Headache Disorders criteria, and found a greater likelihood of migraine (which has photophobia as a diagnostic criterion) in veterans with more frequent injuries and abnormal findings on neurological and neuropsychological exams (39). Clearly, these data are not conclusive, and they speak to the need for more precise ascertainment of both photophobia and headache symptoms after TBI (40). …”

Section: Conditions Associated With Photophobia (Table 1)mentioning

confidence: 99%

Shedding Light on Photophobia

Digre

Brennan²

2012

Journal of Neuro-Ophthalmology

233

239

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Photophobia is a common yet debilitating symptom seen in many ophthalmic and neurologic disorders. Despite its prevalence, it is poorly understood and difficult to treat. However, the past few years have seen significant advances in our understanding of this symptom. We review the clinical characteristics and disorders associated with photophobia, discuss the anatomy and physiology of this phenomenon, and conclude with a practical approach to diagnosis and treatment.

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“…The incidence of head trauma is about 180 to 220 per 100,000 people in North America and 350 per 100,000 people in Europe [9]. An interesting piece of data is that the severity of the head injury is inversely proportional to the occurrence of both acute and chronic PTH.…”

Section: Acute Posttraumatic Headachementioning

confidence: 98%

Headache after Trauma: Physiological Considerations

Láinez

Pesquera

2011

Curr Pain Headache Rep

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Posttraumatic headache (PTH) is one of the most controversial disorders in secondary headaches. It is the most common symptom of postconcussion syndrome. There are many unresolved issues around PTH despite the efforts by the International Headache Society to classify and clarify this entity. This article reviews the classification, pathophysiology, and treatment of PTH, as well as best management of patients with psychiatric comorbidities. Due to the complexity of PTH, the different forms of appearance, its pathophysiology, and the implications of psychological factors, a multidisciplinary team to cover all aspects appears as the best way to approach management and treatment.

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Clinical Review and Epidemiology of Headache Disorders in US Service Members: With Emphasis on Post‐traumatic Headache

Cited by 25 publications

References 19 publications

Update on Chronic Daily Headache

Update on Chronic Daily Headache

Shedding Light on Photophobia

Headache after Trauma: Physiological Considerations

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