Combat-related headache and traumatic brain injury

Area of Science:

• Neurology
• Trauma Care
• Military Health

Background:

• Post-traumatic headache (PTH) is a frequent complication following traumatic brain injury (TBI).
• Distinct differences exist in PTH presentation between combat veterans and civilians with TBI.
• Veterans exhibit higher rates of co-occurring PTSD and sleep disturbances.

Purpose of the Study:

• To review and synthesize current literature on post-traumatic headache in the context of TBI.
• To highlight differences in headache characteristics and associated factors between combat veterans and civilian populations.
• To identify gaps in research and treatment approaches for combat-related PTH.

Main Methods:

• Literature review of studies comparing PTH in combat veterans versus civilians.
• Analysis of associated factors such as PTSD, sleep disturbances, socioeconomic status, rank, and head injury history.
• Examination of discordances in the literature regarding loss of consciousness and headache phenotypes.

Main Results:

• Combat veterans with TBI show unique PTH features, often comorbid with PTSD and sleep disturbances.
• Factors like lower socioeconomic status, rank, and multiple head injuries influence PTH in combat-related TBI.
• Inconsistencies in the literature persist regarding the impact of prolonged loss of consciousness and specific headache types.

Conclusions:

• There is a lack of randomized controlled trials for PTH treatment, likely due to heterogeneous presentation and unclear pathophysiology.
• Current treatment often follows guidelines for primary headaches, but a multimodal and multidisciplinary approach is crucial for combat-related PTH, especially given the link with PTSD.
• Further research is needed to clarify pathophysiologic mechanisms and establish evidence-based treatments for PTH, particularly in veteran populations.