title: Prevalence and treatment of headaches in veterans with mild traumatic brain injury.
abstract: OBJECTIVE
  To report the prevalence and characteristics of headaches in veterans with mild traumatic brain injury (TBI) and to describe most common treatment strategies after neurological evaluation.
  
  
  METHODS
  We conducted a retrospective cohort study. The setting was a United States Veterans Healthcare Administration Polytrauma Network Site. The study participants consisted of 246 veterans with confirmed diagnosis of mild TBI. The main outcome measures were: Self-reported head pain occurring 30 days prior to initial mild TBI screening; headache severity measured by the Neurobehavioral Symptom Inventory; headache characteristics; and treatment prescribed by neurologists.
  
  
  RESULTS
  The majority (74%) of veterans with a confirmed diagnosis of mild TBI (N=246), due largely to blast exposure, reported headaches in the 30 days preceding the initial mild TBI evaluation. Thirty-three percent of these veterans (N=81) were referred to neurology for persistent headaches. Of the 56 veterans attending the neurology evaluation, 45% were diagnosed with migraine headaches and 20% with chronic daily headaches. The most commonly used abortive agents were triptans (68%) and the most common preventive medications were anticonvulsants (55%) and tricyclics (40%).
  
  
  CONCLUSIONS
  There was an increased prevalence of headaches in veterans with mild TBI. Most of the TBI veterans in our study group were exposed to blast injury and findings indicate that the nature of head trauma may be contributing to headaches. Findings highlight the need for developing effective headache prevention and treatment strategies for all persons with mild TBI and in particular for veterans with blast-related mild TBI.
authors.affiliation: Department of Veterans Affairs (VA), Spinal Cord Injury Quality Enhancement Research Initiative, Center for Management of Complex Chronic Care, Edward Hines Jr. VA Hospital, Hines, IL 60141, USA. vijaya.patil2@va.gov
authors.forename: Vijaya K
authors.initials: VK
authors.lastname: Patil
authors.forename: Justin R
authors.initials: JR
authors.lastname: St Andre
authors.forename: Elena
authors.initials: E
authors.lastname: Crisan
authors.forename: Bridget M
authors.initials: BM
authors.lastname: Smith
authors.forename: Charlesnika T
authors.initials: CT
authors.lastname: Evans
authors.forename: Monica L
authors.initials: ML
authors.lastname: Steiner
authors.forename: Theresa L
authors.initials: TL
authors.lastname: Pape
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D001930:Brain Injuries / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D015331:Cohort Studies; D004185:Disability Evaluation; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D006261:Headache / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000700:Analgesics