title: Post-traumatic stress disorder in U.S. soldiers with post-traumatic headache.
abstract: OBJECTIVE
  To determine the impact of post-traumatic stress disorder (PTSD) on headache characteristics and headache prognosis in U.S. soldiers with post-traumatic headache.
  
  
  BACKGROUND
  PTSD and post-concussive headache are common conditions among U.S. Army personnel returning from deployment. The impact of comorbid PTSD on the characteristics and outcomes of post-traumatic headache has not been determined in U.S. Army soldiers.
  
  
  METHODS
  A retrospective cohort study was conducted among 270 consecutive U.S. Army soldiers diagnosed with post-traumatic headache at a single Army neurology clinic. All subjects were screened for PTSD at baseline using the PTSD symptom checklist. Headache frequency and characteristics were determined for post-traumatic headache subjects with and without PTSD at baseline. Headache measures were reassessed 3 months after the baseline visit, and were compared between groups with and without PTSD.
  
  
  RESULTS
  Of 270 soldiers with post-traumatic headache, 105 (39%) met screening criteria for PTSD. There was no significant difference between subjects with PTSD and those without PTSD with regard to headache frequency (17.2 vs 15.7 headache days per month; P = .15) or chronic daily headache (58.1% vs 52.1%; P = .34). Comorbid PTSD was associated with higher headache-related disability as measured by the Migraine Disability Assessment Score. Three months after the baseline neurology clinic visit, the number of subjects with at least 50% reduction in headache frequency was similar among post-traumatic headache cases with and without PTSD (25.9% vs 26.8%).
  
  
  CONCLUSIONS
  PTSD is prevalent among U.S. Army soldiers with post-traumatic headache. Comorbid PTSD is not associated with more frequent headaches or chronic daily headache in soldiers evaluated at a military neurology clinic for chronic post-traumatic headache. Comorbid PTSD does not adversely affect short-term headache outcomes, although prospective controlled trials are needed to better assess this relationship.
authors.affiliation: Neurology Service, Madigan Army Medical Center, Tacoma, WA, USA.
authors.forename: Jacqueline F
authors.initials: JF
authors.lastname: Rosenthal
authors.forename: Jay C
authors.initials: JC
authors.lastname: Erickson
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008889:Military Personnel / Q000523:psychology*; D051298:Post-Traumatic Headache / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: concussion; mild traumatic brain injury; post-traumatic headache; post-traumatic stress disorder