title: Concussion in the Military: an Evidence-Base Review of mTBI in US Military Personnel Focused on Posttraumatic Headache.
abstract: Traumatic brain injury (TBI) is defined as an alteration in brain function caused by an external force. Mild TBI or concussion is now well recognized to be a risk of military service as well as participation in athletic sports such as football. Posttraumatic headache (PTH) is the most common symptom after mTBI in US service members. PTH most commonly presents with migraine-like headache features. The following is an overview of the epidemiology, pathophysiology, clinical course, prognosis, complications, and treatment of mTBI and associated comorbidities with a focus on PTH. There is a particular emphasis on emerging evidence-based clinical practice. One important medical consequence of the recognition that mTBI is a highly prevalent among military service members is that the Department of Defense (DoD) is dedicating significant financial and intellectual resources to better understanding and developing treatments for TBI. The identification of the importance of TBI among the US military population has had the added benefit of increasing awareness of this condition among civilian populations, particularly those engaged in both professional and youth sports. The NIH and NSF are also supporting important TBI research. President Obama's Brain Initiative is also providing additional impetus for these efforts. Unfortunately, the understanding of the acute and chronic effects of mTBI on the brain remains limited. Gratefully, there is hope that through innovative research, there will be advances in elucidating the underlying pathophysiology, which will lead to clinical and prognostic indicators, ultimately resulting in new treatment options for this very complicated set of disorders.
authors.affiliation: Department of Neurology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bldg 19, 6th Floor, Neurology, Bethesda, MD, 20889, USA. Matthew.D.Holtkamp.mil@mail.mil.|Department of Neurology, Uniformed Services University of Health Sciences, Bethesda, MD, USA. Matthew.D.Holtkamp.mil@mail.mil.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Holtkamp
authors.affiliation: Department of Neurology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bldg 19, 6th Floor, Neurology, Bethesda, MD, 20889, USA.|Department of Neurology, Uniformed Services University of Health Sciences, Bethesda, MD, USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Grimes
authors.affiliation: Department of Neurology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bldg 19, 6th Floor, Neurology, Bethesda, MD, 20889, USA.|Department of Neurology, Uniformed Services University of Health Sciences, Bethesda, MD, USA.|Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Ling
mesh_terms: D001924:Brain Concussion / Q000453:epidemiology / Q000235:genetics / Q000503:physiopathology / Q000628:therapy; D015897:Comorbidity; D055317:Evidence-Based Practice; D006801:Humans; D008881:Migraine Disorders / Q000453:epidemiology / Q000235:genetics / Q000503:physiopathology / Q000628:therapy; D008889:Military Personnel / Q000523:psychology / Q000706:statistics & numerical data; D059906:Neuroimaging; D009483:Neuropsychological Tests; D051298:Post-Traumatic Headache / Q000453:epidemiology / Q000235:genetics / Q000503:physiopathology / Q000628:therapy; D011379:Prognosis; D020127:Recovery of Function; D014481:United States / Q000453:epidemiology
keywords: Assessment; Concussion; Headache; Headache disorder; Management; Migraine; Military personnel; Posttraumatic headache; Traumatic brain injury; Treatment; mTBI