Reader Response: Relationship Between Headache Characteristics and a Remote History of TBI in Veterans: A 10-Year Retrospective Chart Review

Abstract

Androulakis et al. advance the classification of traumatic brain injury (TBI)-associated migraine-like headache in army veterans and focus on remote retrospective multidimensional and cumulative effect.1 Paradoxically, their data suggest mild/multiple TBI, moderate TBI, and a longer duration as being statistically more contributory toward headache than other factors, besides alteration of consciousness. Conversely, alterations of consciousness and post-traumatic amnesia for longer than 30 minutes are associated with more severe headache.1 None of the TBI phenotypes offer any clue to pronociceptive ophthalmic trigeminal (V1) neural activations or their link with the eye.2 The investigators do not comment on the role of cortical spreading depression (CSD) in migraine. CSD currently occupies center stage in migraine pathophysiology, both by serendipity and default.2,3 The statistical notion of a complex dose-response relationship between TBI severity and headache outcomes bears scrutiny.