Back to Top Skip to main content

DVBIC study focuses on concussion-related headaches

Soldier (center) standing at attention receives an award pinned to their uniform, from a soldier standing directly before her, with a soldier standing at attention to one side. A long building is seen in the background with two flagpoles, one flying the US flag. Stephanie Ehlers is awarded a Purple Heart on April 8, 2007 for injuries sustained in Iraq. She had bilateral perforations of the eardrums and a TBI. (Photo Courtesy of Stephanie Ehlers)

Recommended Content:

Traumatic Brain Injury | September Toolkit

Headaches are the most common form of pain, according to the National Institutes of Health’s National Library of Medicine. 

Service members with concussion-related headaches often experience more frequent and severe pain compared to those with headaches unrelated to this condition, according to recently published data from the Warrior Strong Study. This multi-year research project was conducted by the Defense and Veterans Brain Injury Center, a division of the Defense Health Agency Research and Development Directorate.

Headaches remain the most frequently reported symptom among service members who have sustained concussions, also known as mild traumatic brain injuries. Seventy-four percent of participants in Operation Enduring Freedom and Operation Iraqi Freedom had post-traumatic headaches within 30 days of sustaining a concussion, as reported by DVBIC.

Between 2009 and 2015, DVBIC researchers surveyed more than 1,500 soldiers, and then followed up with them after three months, then again after six months, and finally, a year later.

“We wanted to find out how active-duty soldiers were doing after coming back from the war zone with concussion,” said Karen Schwab, DVBIC researcher and the study’s principal investigator. Ultimately, the findings may inform DVBIC’s future clinical recommendations and guidelines in the prevention, diagnosis, and treatment of concussions in the U.S. armed forces.

In total, researchers interviewed 1,567 soldiers from combat operations in Afghanistan and Iraq during post deployment health assessments at Fort Carson, Colorado and Fort Bragg, North Carolina. Participants answered 31 headache-related questions to help researchers identify post-traumatic headaches. The soldiers were asked about how frequent and how painful their headaches were, compared to before they deployed, and if their headaches changed after an injury, illness, or some other event during deployment.

Of the 1,094 soldiers who reported headaches, 557 had also experienced concussions. For soldiers whose headaches were related to their concussion, symptoms were more severe and more often led to medical consultation, compared to the group whose headaches were unrelated to TBI.

Post-traumatic headaches often resemble migraines, a painful sensation in the head often associated with nausea and sensitivity to light, among other symptoms.

Notably, the gender composition of the Warrior Strong study differed markedly from studies of migraine headaches in civilian populations. Overall, 91% of the Warrior Strong participants and 94% of those with concussions were male. By contrast, civilian clinical studies on migraines are performed on groups that are around 80% women, a reflection of the demographic fact that adult women are two-to-three times more likely to suffer from migraines than men.

“The evidence base for treating headaches is not specific to post-traumatic headaches. And it may or may not be relevant for treating them. We really don’t know,” said Ann Scher, a professor of epidemiology at Uniformed Services University and the study’s corresponding author.

While there are no specific drug therapies for post-traumatic headaches approved by the Food and Drug Administration, the study results could lead to the design of clinical trials and the development of targeted pharmaceutical remedies, Scher said.

Fortunately, there are multiple behavior changes and medical modalities to treat and reduce the severity of post-traumatic headaches; these include improving sleep patterns, muscle relaxation, anxiety reducing techniques, physical therapy, cognitive behavior therapy, and acupuncture.

To help patients in their care, DVBIC developed the Headache Virtual Suite to offer health care providers a step-by-step process to determine the type of post-traumatic headaches and guidance on its evaluation and treatment.

After her second TBI, former soldier Stephanie Ehlers was told by her medical provider to rest for 24 hours without providing additional therapeutic guidance. When her TBI was more accurately diagnosed a few years later, the former Army Medical Service Corps officer learned various coping methods that set her on the road to recovery.

Ehlers, who also described her experiences as part of DVBIC’s educational campaign called ‘A Head for the Future’, concluded by stating, “Early identification and early treatment of TBI is so important.”

You also may be interested in...

ICD-10 Coding Guidance for TBI

Publication
7/31/2020

DVBIC developed these training slides based on the latest coding guidance and the Military Health System Professional Services and Specialty Medical Coding Guidelines Version 5.0, to facilitate consistent and accurate coding for TBI diagnoses and related symptoms and conditions.

Recommended Content:

Traumatic Brain Injury | TBI Screening | TBI Resources | Traumatic Brain Injury Center of Excellence | Provider Resources | TBI Educators

Management of Sleep Disturbances Following Concussion/mTBI Clinical Recommendation

Publication
7/31/2020

This clinical recommendation outlines how to identify and assess sleep disturbances; primary care manager initial treatment options; and recommended conditions for referral to sleep medicine.

Recommended Content:

Traumatic Brain Injury | TBI Symptoms | TBI Resources | Sleep | Traumatic Brain Injury Center of Excellence | TBI Educators | Provider Resources

Indications and Conditions for In-Theater Post-Injury Neurocognitive Assessment Tool (NCAT) Testing

Publication
7/31/2020

This clinical recommendation provides background of pre-deployment neurocognitive testing and the use of automated neuropsychological assessment metrics.

Recommended Content:

Traumatic Brain Injury | TBI Screening | TBI Resources | Traumatic Brain Injury Center of Excellence | TBI Educators | Provider Resources

Management of Headache Following Concussion/mTBI Clinical Support Tool

Publication
7/31/2020

This clinical support tool uses an algorithmic approach for health care providers to help assess and manage headache in service members and veterans who sustain a mild TBI and experience post-traumatic headache (PTH). The tool offers providers a step-by-step process to determine the type of headache following mild TBI and indications for emergency or specialty referral.

Recommended Content:

Traumatic Brain Injury | TBI Screening | TBI Symptoms | TBI Resources | Traumatic Brain Injury Center of Excellence | TBI Educators | Provider Resources

Cognitive Rehabilitation for Following Mild to Moderate TBI Clinical Recommendation - Full

Publication
7/30/2020

This clinical recommendation is broken down into three primary categories: Modifications for Service Members and Veterans; Interventions and Strategies to Address Cognitive Dysfunction; and, Delivery of Rehabilitation for Patients with Cognitive Challenges. Each category contains clinical recommendations, the background and rationale behind them, evidence review references, and clinical resources.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Educators | Provider Resources | TBICoE Research | Cognitive Rehabilitation Therapy | Traumatic Brain Injury | TBI Resources

Cognitive Rehabilitation Following Mild to Moderate TBI - Referring Provider Resource

Publication
7/30/2020

This document answers common questions that referring providers may have, such as how to determine if a patient is having cognitive difficulties or whether the patient is a good candidate for cognitive rehabilitation.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Educators | Provider Resources | TBICoE Research | Cognitive Rehabilitation Therapy | Traumatic Brain Injury | TBI Resources

Cognitive Rehabilitation Following Mild to Moderate TBI Clinical Recommendation - Short

Publication
7/30/2020

This short version of the Cognitive Rehabilitation Following Mild to Moderate TBI Clinical Recommendation provides an at-a-glance overview of the full-length version for quick access and use on the job.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Educators | Provider Resources | TBICoE Research | Cognitive Rehabilitation Therapy | Traumatic Brain Injury | TBI Resources

Concussion Management Tool

Publication
7/30/2020

The CMT revises and replaces the 2012 Concussion Management Algorithm and the 2014 Army Concussion Management in the Garrison Setting Algorithm. The CMT replaces the prior CMA to better align with the current MACE 2, Progressive Return to Activity, and DVBIC clinical recommendations.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Educators | Provider Resources | Traumatic Brain Injury | TBI Screening | TBI Resources

Recurrent Concussion Evaluation

Publication
7/30/2020

The Recurrent Concussion Evaluation card is designed to guide providers in the management of patients with a history of three or more documented concussions within a 12-month span.

Recommended Content:

TBI Educators | Provider Resources | DoD TBI Worldwide Numbers | Traumatic Brain Injury | TBI Screening | TBI Resources

Assessment and Management of Dizziness Associated with Mild TBI Clinical Recommendation

Publication
7/30/2020

The Assessment and Management of Dizziness Associated with Mild TBI Clinical Recommendation and Clinical Support Tool provide primary care providers with an approach to evaluate dizziness following mild TBI and offers guidance on referral for further vestibular evaluation and care.

Recommended Content:

Traumatic Brain Injury | TBI Resources | Traumatic Brain Injury Center of Excellence | TBI Educators | Provider Resources

Military Acute Concussion Evaluation 2 (MACE 2)

Publication
7/30/2020

The 2018 Military Acute Concussion Evaluation 2 (MACE 2) is an acute assessment tool for all medically trained personnel who treat service members involved in a potentially concussive event. The MACE 2 incorporates current state-of-the-science traumatic brain injury information, including vestibular-ocular-motor screening. The MACE 2 is an update to and replaces the original MACE.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Educators | Provider Resources | Traumatic Brain Injury

Neck Pain Following Concussion/mTBI Fact Sheet

Fact Sheet
7/30/2020

Neck pain can occur together with headaches following a concussion. This fact sheet provides information to help patients manage neck pain. Various techniques are explained, including the use of heat or cold therapy, neck stretches, proper sleep positions and common activities that may contribute to neck strain.

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence | TBI Educators | Provider Resources | DoD TBI Worldwide Numbers

Concussion/Mild TBI Signs and Symptoms Fact Sheet

Fact Sheet
7/30/2020

This fact sheet identifies major physical, cognitive and emotional symptoms of concussion and provides coping and recovery tips.

Recommended Content:

Traumatic Brain Injury | TBI Prevention | TBI Screening | TBI Symptoms | TBI Resources | Traumatic Brain Injury Center of Excellence | TBI Educators | Patient and Family Resources | Provider Resources | TBICoE Research | A Head for the Future

Chronic Traumatic Encephalopathy (CTE) Frequently Asked Questions

Fact Sheet
7/30/2020

This fact sheet provides answers and information to commonly asked questions about chronic traumatic encephalopathy, or CTE.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Educators | Provider Resources | Patient and Family Resources | TBICoE Research | Traumatic Brain Injury | TBI Resources

Healthy Sleep Following Concussion/mTBI Fact Sheet

Fact Sheet
7/30/2020

Getting restful sleep is one of the most important things you can do for your health, and it often takes thoughtful preparation during the day. This fact sheet offers service members and veterans who experience sleep disturbances with healthy sleep tips that can likely improve their sleep.

Recommended Content:

Traumatic Brain Injury | TBI Symptoms | TBI Resources | TBI Prevention | Traumatic Brain Injury Center of Excellence | TBI Educators | Patient and Family Resources | Provider Resources | A Head for the Future
<< < ... 6 7 8 9 10  ... > >> 
Showing results 76 - 90 Page 6 of 13

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.