Sports Medicine Research: In the Lab & In the Field: Chronic Daily Headache in U.S. Soldiers After Concussion (Sports Med Res)
Wednesday, May 2, 2012

Chronic Daily Headache in U.S. Soldiers After Concussion

Chronic daily headache in U.S. soldiers after concussion

Theeler BJ, Flynn FG, Erickson JC. Headache. 2012; ahead of print.

Concussions occur in almost a fifth of the United States service members that are deployed and the most common sign and symptom is headache. Headaches following a concussion can last for up to a month. Chronic daily headache (CDH) is defined as 15 or more headache days per month and little is known on the association between CDH and concussions. Therefore, the purpose of this study was to determine the prevalence, characteristics, and other factors that are associated with CDHs in United States soldiers who had a previous history of a concussion. This was a cross-sectional questionnaire based study with a cohort of 978 soldiers who had a diagnosed concussion upon returning from Iraq or Afghanistan. Information about the head trauma was obtained by interviewing the soldier and from their medical records. The soldiers also took several questionnaires [i.e., Madigan Redeployment Evaluation of Concussion (MREC), Posttraumatic stress disorder (PTSD) was evaluated by the PTSD checklist PCL (military version), and a traumatic brain injury questionnaire]. The MREC is a neurocognitive-screening tool for concussions specifically for returning soldiers. The PTSD test is a checklist of signs and symptoms of PTSD. A global measure of the severity of their traumatic brain injury was determined by a 2-plus-10 questionnaire (2 yes/no questions followed by 10 injury screening questions using a Likert scale). Overall, 957 (20%) reported headaches in the preceding 3 months. Concussions occurred most commonly due to an explosive blast (~80%). Twenty percent of those with a history of deployment-related concussions and reporting headaches reported 15 or more headache days per month for the previous 3 months thus qualifying to be diagnosed with CDH, 78% were categorized as patients with episodic headaches. These soldiers with CDH had a median of 26.7 headache days per month and had the headache syndrome for about 11.5 months. Fifty-five percent of those with CHD had an onset of headaches within 1 week of their concussion compared to only 33% of those with episodic headaches. There was no significant difference between mechanism of injury (e.g., blast or non blast) or number of previous concussion between soldiers with CDH and episodic headaches. Significant signs and symptoms associated with CDH compared to those with episodic headaches are phonophobia (sensitive to noise) or photophobia (77%; sensitivity to light), nausea (45%), disruption of activities of daily life (55%), worse with physical exertion (66%), and throbbing (88%). In addition nearly half (49%) of the CDH soldiers used therapeutic analgesics 15 or more days a month to treat the headache compared to soldiers with episodic headaches who took medication an average of 3.3 days a month. CHD soldiers’ traumatic brain injury score mean was 14.4 out of a possible 39, which was significantly higher than those with episodic headaches (12.0). More soldiers with CDH (41%) had a PCL score greater than 50, a positive screen for PTSD, compared to those with episodic headaches (18%).

The prevalence rate of concussions within returning soldiers is ~20%. Though there was no significant difference between mechanism or concussion history there seems to be a difference in many other factors between those soldiers diagnosed with CDH compared to those with episodic headaches (e.g., signs and symptoms, questionnaire scores, amount of medication used). Head trauma, regardless of mechanism or number of previous concussions, has been shown to trigger new headaches or exacerbate preexisting headaches. The soldiers diagnosed with CHD had significantly greater PTSD PCL score, so posttraumatic stress may exacerbate or contribute to headache frequency following a concussion. Also many of those with CDH had used medication to alleviate pain; however, medication overuse has been associated to transforming episodic headaches to chronic migraines. The prevalence rate of concussions in the athletic field is also ~20% and headache is also the most common symptom reported. Though, the mechanism of concussion is much different do you think some of the athletes’ concussion signs and symptoms are exacerbated by the posttraumatic stress of the injury? Have you noticed athletes with a history of concussions reporting CHD?

Written by: Jane McDevitt MS, ATC, CSCS
Reviewed by: Jeffrey Driban

Related Posts:

Theeler BJ, Flynn FG, & Erickson JC (2012). Chronic Daily Headache in U.S. Soldiers After Concussion. Headache PMID: 22404747

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