title: Onabotulinum toxin a for the treatment of headache in service members with a history of mild traumatic brain injury: a cohort study.
abstract: OBJECTIVE
  Post-traumatic headache (PTH) of the migraine type is a common complication of mild traumatic brain injury (including blast injuries) in active duty service members. Persistent and near-daily headache occur. Usual preventive medications may have unacceptable side effects. Anecdotal reports suggest that onabotulinum toxin A (OBA) might be an effective treatment in these patients.
  
  
  METHODS
  This study is a real-time retrospective consecutive case series of all patients treated with OBA at the Concussion Care Clinic of Womack Army Medical Center, Ft. Bragg, NC, between August 2008 and August 2012. Clinical treatment and pharmacy records were corroborated with the electronic medical records in the Armed Forces Health Longitudinal Technology Application to determine demographics, current headache and treatment characteristics, and clinical and occupational outcomes.
  
  
  RESULTS
  Sixty-four subjects (63 male) with mean age of 31.3 + 7.5 (range 20-59) years were evaluated and treated. Blast injuries were most common (n = 36; 56.3%) and 7 patients (11%) reported a prior history of headache. Most patients (36; 56.3%) described more than 1 headache type and 48 (75%) patients had continuous pain. The most prevalent treating diagnosis was mixed continuous headache with migraine features on more than 15 days per month (n = 26; 40.6%). The mean time from injury to the first injections was 10.8 + 21.9 (1-96) months. Forty (62.5%) patients received the Food and Drug Administration-approved chronic migraine injection protocol. Forty-one (64%) patients reported being better. Two patients discontinued for side effects. Twenty-seven (41%) remained on active duty.
  
  
  CONCLUSIONS
  We demonstrate that active duty military patients with headaches related to concussions may benefit from treatment with OBA. Further studies are indicated.
authors: Department of Brain Injury Medicine, Womack Army Medical Center (WAMC), Ft. Bragg, NC, USA.
authors: Juanita A
authors: JA
authors: Yerry
authors: Devon
authors: D
authors: Kuehn
authors: Alan G
authors: AG
authors: Finkel
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D001930:Brain Injuries / Q000150:complications*; D015331:Cohort Studies; D005260:Female; D006261:Headache / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: botulinum toxin; chronic migraine; headache; migraine; military; traumatic brain injury