Chronic daily
headache in U.S. soldiers after concussion

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

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%).

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?

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

Related Posts:

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