Headaches during war: Analysis of presentation, treatment, and factors associated with outcome

Cohen, Steven P.; Plunkett, Anthony; Wilkinson, Indy; Nguyen, Conner; Kurihara, Connie; Flagg, Artemus; Morlando, Benny; Stone, Christina; White, Ronald L.; Anderson-Barnes, Victoria C.; Galvagno, Samuel M.

doi:10.1177/0333102411422382

Cited by 46 publications

(46 citation statements)

References 31 publications

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“…6,72 Rare cases of PTH in the civilian population are phenotypically similar to cluster headaches, 73 hemicrania continua, 74 chronic paroxysmal hemicranias, 75 and short-lasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing (SUNCT syndrome). 78 Most recent US military PTHs developed following blast exposure. 28 Leakage of cerebrospinal fluid (CSF) can produce low CSF pressure headaches.…”

Section: Box 2-post-traumatic Headaches (Pths)mentioning

confidence: 99%

Post‐Traumatic Headaches in Civilians and Military Personnel: A Comparative, Clinical Review

et al. 2013

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Post-traumatic headache (PTH) is the most frequent symptom after traumatic brain injury (TBI). We review the epidemiology and characterization of PTH in military and civilian settings. PTH appears to be more likely to develop following mild TBI (concussion) compared with moderate or severe TBI. PTH often clinically resembles primary headache disorders, usually migraine. For migraine-like PTH, individuals who had the most severe headache pain had the highest headache frequencies. Based on studies to date in both civilian and military settings, we recommend changes to the current definition of PTH. Anxiety disorders such as post-traumatic stress disorder (PTSD) are frequently associated with TBI, especially in military populations and in combat settings. PTSD can complicate treatment of PTH as a comorbid condition of post-concussion syndrome. PTH should not be treated as an isolated condition. Comorbid conditions such as PTSD and sleep disturbances also need to be treated. Double-blind placebo-controlled trials in PTH population are necessary to see whether similar phenotypes in the primary headache disorders and PTH will respond similarly to treatment. Until blinded treatment trials are completed, we suggest that, when possible, PTH be treated as one would treat the primary headache disorder(s) that the PTH most closely resembles.

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Section: Box 2-post-traumatic Headaches (Pths)mentioning

confidence: 99%

Post‐Traumatic Headaches in Civilians and Military Personnel: A Comparative, Clinical Review

et al. 2013

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“…35 ON is frequently associated with head trauma and whiplash injuries. 15,19,40 In one study evaluating service members evacuated from Operations Iraqi and Enduring Freedom with headaches, 4.9% were given a primary diagnosis of ON. 15 However, these statistics may belie the socioeconomic burden of conditions that may respond to interventions targeting the occipital nerve(s), as approximately 50% of migraineurs, 2,5,6,11,23,48 a majority of individuals with cluster headache, 2,4,23,37,45 and significant proportions of individuals with tension-type, 8,48 posttraumatic, 29,48 and cervicogenic headaches 8,23,29 also respond to occipital nerve block.…”

Section: Introductionmentioning

confidence: 99%

Randomized, double-blind, comparative-effectiveness study comparing pulsed radiofrequency to steroid injections for occipital neuralgia or migraine with occipital nerve tenderness

Cohen

Peterlin

Fulton

et al. 2015

Pain

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Occipital neuralgia (ON) is characterized by lancinating pain and tenderness overlying the occipital nerves. Both steroid injections and pulsed radiofrequency (PRF) are used to treat ON, but few clinical trials have evaluated efficacy, and no study has compared treatments. We performed a multicenter, randomized, double-blind, comparative-effectiveness study in 81 participants with ON or migraine with occipital nerve tenderness whose aim was to determine which treatment is superior. Forty-two participants were randomized to receive local anesthetic and saline, and three 120 second cycles of PRF per targeted nerve, and 39 were randomized to receive local anesthetic mixed with deposteroid and 3 rounds of sham PRF. Patients, treating physicians, and evaluators were blinded to interventions. The PRF group experienced a greater reduction in the primary outcome measure, average occipital pain at 6 weeks (mean change from baseline −2.743 ± 2.487 vs −1.377 ± 1.970; P <0.001), than the steroid group, which persisted through the 6-month follow-up. Comparable benefits favoring PRF were obtained for worst occipital pain through 3 months (mean change from baseline−1.925 ± 3.204 vs−0.541 ± 2.644; P = 0.043), and average overall headache pain through 6 weeks (mean change from baseline −2.738 ± 2.753 vs −1.120 ± 2.1; P = 0.037). Adverse events were similar between groups, and few significant differences were noted for nonpain outcomes. We conclude that although PRF can provide greater pain relief for ON and migraine with occipital nerve tenderness than steroid injections, the superior analgesia may not be accompanied by comparable improvement on other outcome measures.

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“…It innervates the lateral scalp and the area just posterior to the auricle (9). The TON is a branch of C3, which emerges inferiorly (7) and innervates the upper neck and lower occipital scalp (9). …”

Section: Discussionmentioning

confidence: 99%

“…ON commonly results from head trauma such as that associated with concussion and/or whiplash injuries seen in sports, motor vehicle accidents, and war zones (7). However, ON also may stem from compression due to degenerative spine changes, malignant growths, extra and intracranial vessels, giant cell arteritis, bony callus formation after vertebral fracture, or chronically contracted spinal muscles (13,17).…”

Section: Discussionmentioning

confidence: 99%

Occipital Neuralgia as a Sequela of Sports Concussion

Zaremski

Herman

Clugston

et al. 2015

Current Sports Medicine Reports

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Headaches during war: Analysis of presentation, treatment, and factors associated with outcome

Abstract: Headaches represent a significant cause of unit attrition in personnel deployed in military operations, with physical trauma and co-existing psychopathology associated with poorer outcomes.

Cited by 46 publications

References 31 publications

Post‐Traumatic Headaches in Civilians and Military Personnel: A Comparative, Clinical Review

Post‐Traumatic Headaches in Civilians and Military Personnel: A Comparative, Clinical Review

Randomized, double-blind, comparative-effectiveness study comparing pulsed radiofrequency to steroid injections for occipital neuralgia or migraine with occipital nerve tenderness

Occipital Neuralgia as a Sequela of Sports Concussion

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