Prevalence and Treatment of Headaches in Veterans With Mild Traumatic Brain Injury

Patil, Vijaya; Andre, Justin R. St.; Crisan, Elena; Smith, Bridget; Evans, Charlesnika T.; Steiner, M; Pape, Theresa

doi:10.1111/j.1526-4610.2011.01946.x

Cited by 47 publications

(50 citation statements)

References 35 publications

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“…42,43 TRPV1 antagonists have also been evaluated in the treatment of this disorder 44 . Of direct relevance to our research, a significant percentage of military veterans with blast-related injuries and confirmed TBI have also been diagnosed with migraine headaches and/or chronic, daily headaches 45 . Inflammatory cytokines are known to play a significant role in trigeminal nerve sensitization regulation in migraines.…”

Section: Discussionmentioning

confidence: 99%

Low-Level Blast Exposure Increases Transient Receptor Potential Vanilloid 1 (TRPV1) Expression in the Rat Cornea

Por

Choi

Lund

2016

Current Eye Research

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Background: Blast-related ocular injuries sustained by military personnel have led to rigorous efforts to elucidate the effects of blast exposure on neurosensory function. Recent studies have provided some insight into cognitive and visual deficits sustained following blast exposure; however, limited data are available on the effects of blast on pain and inflammatory processes. Investigation of these secondary effects of blast exposure is necessary to fully comprehend the complex pathophysiology of blast-related injuries. The overall purpose of this study is to determine the effects of single and repeated blast exposure on pain and inflammatory mediators in ocular tissues. Methods: A compressed air shock tube was used to deliver a single or repeated blast (68.0 ± 2.7 kPa) to anesthetized rats daily for 5 days. Immunohistochemistry was performed on ocular tissues to determine the expression of the transient receptor potential vanilloid 1 (TRPV1) channel, calcitonin gene-related peptide (CGRP), substance P (SP), and endothelin-1 (ET-1) following single and repeated blast exposure. Neutrophil infiltration and myeloperoxidase (MPO) expression were also assessed in blast tissues via immunohistochemistry and enzyme-linked immunosorbent assay (ELISA) analysis, respectively. Results: TRPV1 expression was increased in rat corneas exposed to both single and repeated blast. Increased secretion of CGRP, SP, and ET-1 was also detected in rat corneas as compared to control. Moreover, repeated blast exposure resulted in neutrophil infiltration in the cornea and stromal layer as compared to control animals. Conclusion: Single and repeated blast exposure resulted in increased expression of TRPV1, CGRP, SP, and ET-1 as well as neutrophil infiltration. Collectively, these findings provide novel insight into the activation of pain and inflammation signaling mediators following blast exposure.

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Section: Discussionmentioning

confidence: 99%

Low-Level Blast Exposure Increases Transient Receptor Potential Vanilloid 1 (TRPV1) Expression in the Rat Cornea

Por

Choi

Lund

2016

Current Eye Research

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“…10 We suspect that the duration of the time window in part reflected a concern that a longer window would increase the number of people who would claim to have PTH for secondary gain including medicolegal issues. 1,3,20,21,50,52,79,80,[88][89][90]154,155 Longitudinal imaging studies demonstrate evolving brain changes occurring over years following TBI. 90 We suggest the longer time window in order to include people whom we observed developed headaches more than 7 days after TBI (see sections on PTH in civilians and military PTH).…”

Section: Box 6-relationship Of Post-traumatic Stress Disorder (Ptsd)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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“…PTH is more frequent after mild TBI (mTBI) compared with moderate or severe TBI 2 and can resemble one or more primary headache disorders 3– 9 . The most common PTH patterns resemble two primary headache disorders—migraine or probable migraine and tension-type headaches—and migraine-type headaches are more prevalent 3– 5, 8, 10, 11 . In one prospective study of adult civilian TBI associated with motor vehicle accidents, 58% of subjects continued to have PTH one year after their TBI 12 .…”

Section: Introductionmentioning

confidence: 99%

“…In one prospective study of adult civilian TBI associated with motor vehicle accidents, 58% of subjects continued to have PTH one year after their TBI 12 . Migraine-like PTHs usually resemble migraine without aura 5, 7, 8, 13, 14 . Neck injury in conjunction with TBI can result in cervicogenic headaches or pain that may resemble occipital neuralgia 11, 15 .…”

Section: Introductionmentioning

confidence: 99%

Pathophysiological links between traumatic brain injury and post-traumatic headaches

Ruff

Blake

2016

F1000Res

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This article reviews possible ways that traumatic brain injury (TBI) can induce migraine-type post-traumatic headaches (PTHs) in children, adults, civilians, and military personnel. Several cerebral alterations resulting from TBI can foster the development of PTH, including neuroinflammation that can activate neural systems associated with migraine. TBI can also compromise the intrinsic pain modulation system and this would increase the level of perceived pain associated with PTH. Depression and anxiety disorders, especially post-traumatic stress disorder (PTSD), are associated with TBI and these psychological conditions can directly intensify PTH. Additionally, depression and PTSD alter sleep and this will increase headache severity and foster the genesis of PTH. This article also reviews the anatomic loci of injury associated with TBI and notes the overlap between areas of injury associated with TBI and PTSD.

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Prevalence and Treatment of Headaches in Veterans With Mild Traumatic Brain Injury

Cited by 47 publications

References 35 publications

Low-Level Blast Exposure Increases Transient Receptor Potential Vanilloid 1 (TRPV1) Expression in the Rat Cornea

Low-Level Blast Exposure Increases Transient Receptor Potential Vanilloid 1 (TRPV1) Expression in the Rat Cornea

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

Pathophysiological links between traumatic brain injury and post-traumatic headaches

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