title: Headaches after concussion in US soldiers returning from Iraq or Afghanistan.
abstract: OBJECTIVE
  To determine the prevalence, characteristics, impact, and treatment patterns of headaches after concussion in US Army soldiers returning from a deployment to Iraq or Afghanistan.
  
  
  METHODS
  A cross-sectional study was conducted with a cohort of soldiers undergoing postdeployment evaluation during a 5-month period at the Madigan Traumatic Brain Injury Program at Ft. Lewis, WA. All soldiers screening positive for a deployment-related concussion were given a 13-item headache questionnaire.
  
  
  RESULTS
  A total of 1033 (19.6%) of 5270 returning soldiers met criteria for a deployment-related concussion. Among those with a concussion, 957 (97.8%) reported having headaches during the final 3 months of deployment. Posttraumatic headaches, defined as headaches beginning within 1 week after a concussion, were present in 361 (37%) soldiers. In total, 58% of posttraumatic headaches were classified as migraine. Posttraumatic headaches had a higher attack frequency than nontraumatic headaches, averaging 10 days per month. Chronic daily headache was present in 27% of soldiers with posttraumatic headache compared with 14% of soldiers with nontraumatic headache. Posttraumatic headaches interfered with duty performance in 37% of cases and caused more sick call visits compared with nontraumatic headache. In total, 78% of soldiers with posttraumatic headache used abortive medications, predominantly over-the-counter analgesics, and most perceived medication as effective.
  
  
  CONCLUSIONS
  More than 1 in 3 returning military troops who have sustained a deployment-related concussion have headaches that meet criteria for posttraumatic headache. Migraine is the predominant headache phenotype precipitated by a concussion during military deployment. Compared with headaches not directly attributable to head trauma, posttraumatic headaches are associated with a higher frequency of headache attacks and an increased prevalence of chronic daily headache.
authors.affiliation: William Beaumont Army Medical Center, Department of Medicine, Neurology Service, Medical Corps, United States Army, Fort Bliss, TX 79920-5001, USA.
authors.forename: Brett J
authors.initials: BJ
authors.lastname: Theeler
authors.forename: Frederick G
authors.initials: FG
authors.lastname: Flynn
authors.forename: Jay C
authors.initials: JC
authors.lastname: Erickson
mesh_terms: D000328:Adult; D000346:Afghanistan / Q000453:epidemiology; D001753:Blast Injuries / Q000453:epidemiology* / Q000503:physiopathology; D001924:Brain Concussion / Q000453:epidemiology* / Q000503:physiopathology; D015331:Cohort Studies; D015897:Comorbidity / Q000639:trends; D003430:Cross-Sectional Studies; D005260:Female; D006261:Headache / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D007493:Iraq / Q000453:epidemiology; D008297:Male; D008889:Military Personnel / Q000523:psychology; D014857:Warfare