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

Authors

  • Brett Theeler MD,

    1. Department of Neurology, Walter Reed National Military Medical Center, Bethesda, MD, USA
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  • Sylvia Lucas MD, PhD,

    1. Departments of Neurology, Neurosurgery and Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA, USA
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  • Ronald G Riechers II MD,

    1. Neurology and Polytrauma Services, Cleveland VA Medical Center, Cleveland, OH, USA
    2. Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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  • Robert L Ruff MD, PhD

    Corresponding author
    1. Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
    2. Department of Neurosciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
    • Neurology and Polytrauma Services, Cleveland VA Medical Center, Cleveland, OH, USA
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  • Conflict of Interest: None.
  • Disclaimer: The authors have nothing to disclose. The views expressed are those of the author(s) and do not reflect the official policy of Walter Reed National Military Medical Center, the Department of the Army, the Department of Defense, the Department of Veterans Affairs, or the US Government.

Address all correspondence to R.L. Ruff, Neurology and Polytrauma Services 127(W), Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA.

Abstract

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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