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Keywords:

  • post-traumatic headache;
  • traumatic brain injury;
  • military population

(Headache 2011;51:945-953)

Objective.— The current study used a cross-sectional observational design to evaluate the relationship between psychological, physiological, and contextual factors and headache severity among 133 deployed military personnel and 4 civilian contractors diagnosed with mild traumatic brain injury (mTBI) referred to a combat support hospital in Iraq.

Background.— Although TBI and headache sequelae have been documented for military combatants, little is known about factors associated with headache severity.

Methods.— Military personnel (n = 157) and civilian (n = 4) contractors referred to a combat support hospital in Iraq underwent a standardized intake evaluation which included computerized neurocognitive testing, psychological and physical health questionnaires, a clinical interview, and a physical examination by a physician.

Results.— Results of zero-inflated Poisson regression modeling suggest that insomnia is associated with increased likelihood for endorsement of any headache, but loss of consciousness, post-traumatic stress disorder symptoms, and slowed reaction time only are predictive of headache severity. Among the subset of patients presenting to the combat support hospital within 7 days of mTBI (n = 101), number of TBI symptoms demonstrated a non-significant trend toward increased likelihood of headache endorsement of any kind, with loss of consciousness, post-traumatic stress disorder, and slowed reaction time demonstrating significant relationships with headache severity.

Conclusion.— Knowledge of predictors of post-concussive headache onset and severity may assist clinicians in making important decisions regarding treatment recommendations for veterans with mTBI.