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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)

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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.”

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Diagnoses of Traumatic Brain Injury Not Clearly Associated with Deployment, Active Component, U.S. Armed Forces, 2001 – 2016

Infographic
4/4/2017
Traumatic Brain Injury (TBI) is structural alteration of the brain or physiological disruption of brain function caused by an external force.  TBI, particularly mild TBI or concussion, is the most common traumatic injury in the U.S. military. This analysis provides the estimated rates of incident TBIs among service members before their first-ever deployment as well as separately among service members during deployments/ after deployments. It also mentions factors that may explain why the TBI incidence rates among the previously deployed were higher than those of the never-deployed group. Moreover, it describes the demographic and military traits of service members diagnosed as TBI cases (before/after deployment). Categorization of person time during surveillance period included four categories: Group 1 (Never deployed/TBI before first-ever deployment), Group 2 (Currently deployed or within 30 days of return), Group 3 (previously deployed but not currently deployed nor within 30 days of return) and Censored after Diagnosis of TBI. From 2001-2016, 276,858 active component service members received first-time diagnoses of TBI. The crude overall incidence rate of TBI among deployed service members was 1.5 times that of service members assigned to Group 1 and 1.2 times that of service members in Group 3 during the surveillance period.  Total TBI cases by group were Group 1 42.8%, Group 2 13.2% and Group 3 44.0%. Incidence rates by group (per 100,000 person-years) were Group 1 1,141.3, Group 2 1,690.5, and Group 3 1,451.2. Learn more at www.Health.mil/MSMR and see fact sheets at www.Health.mil/AFHSB

Traumatic Brain Injury (TBI) is structural alteration of the brain or physiological disruption of brain function caused by an external force. TBI, particularly mild TBI or concussion, is the most common traumatic injury in the U.S. military. This analysis provides the estimated rates of incident TBIs among service members before their first-ever deployment as well as separately among service members during deployments/ after deployments. It also mentions factors that may explain why the TBI incidence rates among the previously deployed were higher than those of the never-deployed group. Moreover, it describes the demographic and military traits of service members diagnosed as TBI cases (before/after deployment).

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