Headache in military service members with a history of mild traumatic brain injury: A cohort study of diagnosis and classification

Abstract

Introduction Headaches after concussion are highly prevalent, relatively persistent and are being treated like primary headaches, especially migraine. Methods We studied all new patients seen between August 2008 and December 2009 assessed by a civilian headache specialist at the TBI Center at Womack Army Medical Center, Fort Bragg, NC. We report sample demographics, injuries and headache characteristics, including time from injury to headache onset, detailed descriptions and International Classification of Headache Disorders second edition primary headache diagnosis type. Results A total of 95 soldiers reported 166 headaches. The most common injury cited was a blast (53.7%). Most subjects (76.8%) recalled the onset of any headache within 7 days of injury. The most commonly diagnosed headache was a continuous type with migraine features ( n = 31 (18.7%)), followed by chronic migraine (type 1.5.1, n = 14 (8.4%)), migraine with aura (type 1.2.1, n = 10 (6.0%)), hemicrania continua (type 4.7, n = 12 (7.2%)), chronic cluster (type 3.1.2, n = 6 (3.6%)) and headaches not otherwise classifiable (type 14.1, n = 5 (3.0%)) also present. The most clinically important was a continuous headache with migraine features. Conclusion We present a series of patients seen in a military treatment facility for headache diagnosis after concussion in whom we found migraine, as well as uncommon primary headache types, at frequencies that were much higher than expected.

Painful Craniofacial/Cervical Surface Area and Continuous Headache After Military Concussion: A Morphometric Retrospective Cohort Study

“…One patient with 3 distinct headaches was excluded from statistical analysis due to missing clinical data. Patients with complete data ( n = 34, reporting 58 headaches) were analyzed, and had a similar demographic profile to those previously reported with a mean age of 30.3 ± 7.00 (Table ). Fifty‐nine percent (20/34) attributed their PTH to blast injury; 85% (29/34) reported a continuous headache; 15% (5/34) reported non‐continuous headaches only.…”

“…The retrospective cohort of 95 soldiers previously reported had a mean age of 31.7 years and was 94% male. These ADSMs were seen clinically between August 2008 and January 2010.…”

“…Based on these descriptions, criteria were applied for a maximum of 1 continuous and 2 non‐continuous headaches. The clinically most important headache was derived by patient identification and clinician judgment as previously described …”

Which Matters More? A Retrospective Cohort Study of Headache Characteristics and Diagnosis Type in Soldiers with mTBI/Concussion

“…Patients were asked how many headaches were experienced in the last month and to list the characteristics of those headaches (up to a maximum of one continuous headache and two non‐continuous headaches) as previously described …”

Hemicrania continua: clinical review, diagnosis and management

“…It composed 39% of total cases of secondary HC. Finkel et al35 studied the headache pattern in military service members with a history of mild traumatic brain injury. They noted 12 patients with HC (consisting 7.2% of total cases).…”