Persistent posttraumatic headaches and functioning in veterans: Injury type can matter

Abstract

Objective To characterize the relationship between head trauma types (blast injury, blunt injury, combined blast+blunt injury) with subsequent headache presentations and functioning. Background Posttraumatic headaches (PTHs), the most common sequelae of traumatic brain injury (TBI), are painful and disabling. More than 400,000 veterans report having experienced a TBI, and understanding the predictors of PTHs may guide treatment developments. Methods This study used a nested‐cohort design analyzing baseline data from a randomized clinical trial of cognitive behavioral therapy for PTH (N = 190). Participants had PTH (from blast and/or blunt head trauma) and symptoms of posttraumatic stress disorder (PTSD). The Structured Diagnostic Interview for Headache‐Revised and Ohio State University Traumatic Brain Injury Identification Method were used to phenotype headaches and head injury histories, respectively. Results Individuals with persistent PTHs after a combined blast and blunt head trauma were more likely (OR =3.45; 95% CI [1.41, 8.4]) to experience chronic (vs. episodic) PTHs compared with the blunt trauma only group (23/33, 70% vs. 26/65, 40%, respectively); and they were more likely (OR =2.51; 95% CI [1.07, 5.9]) to experience chronic PTH compared with the blast trauma only group (44/92, 48%). There were no differences between head injury type on headache‐related disability, depression symptoms, or severity of PTSD symptoms. Conclusion The combination of blast and blunt injuries was associated with headache chronicity, but not headache disability. Considering the refractory nature of chronic headaches, the potential added and synergistic effects of distinct head injuries warrant further study.

Persistence of headache and its relation to other major sequelae following traumatic brain injury at 2–8 years after deployment‐related traumatic brain injury in veterans of Afghanistan and Iraq wars

“…To date, however, most reports find no evidence that blast injury and DHT produce significantly different outcomes for STBI 3,26,41 . One recent study found minimal differences 42 …”

“…They found headache was more common in those with LOC (p < 0.05) and memory problems were more common in those with no LOC.Couch and Stewart in a smaller study dealing with headache found no difference between those with blast or DHT 26. A recent study by Nabity et al reported worse headache with blast injury, however, the odds ratios were not statistically significantly different 42.…”

“…3,26,41 One recent study found minimal differences. 42 Another aspect of the study is the reporting of symptom severity or burden. For the TBI clinic of Oklahoma City VA Health Sciences Center, the CTBIE, which uses a five-point Likert Scale, was the data collection instrument used.…”

The road taken

“…In the article "Persistent posttraumatic headaches and functioning in Veterans: Injury type can matter," study subjects were enrolled in a randomized controlled trial of cognitive behavior therapy for the treatment of posttraumatic headache. 1 The current study was designed to test three hypotheses: (1) to determine the landscape of this population of injured veterans presenting for care where injury mechanisms were categorized into three groups Blast, Blunt, and both;…”

“…In the article “Persistent posttraumatic headaches and functioning in Veterans: Injury type can matter,” study subjects were enrolled in a randomized controlled trial of cognitive behavior therapy for the treatment of posttraumatic headache 1 …”