title: Headache in military service members with a history of mild traumatic brain injury: A cohort study of diagnosis and classification.
abstract: Introduction Headaches after concussion are highly prevalent, relatively persistent and are being treated like primary headaches, especially migraine. Methods We studied all new patients seen between August 2008 and December 2009 assessed by a civilian headache specialist at the TBI Center at Womack Army Medical Center, Fort Bragg, NC. We report sample demographics, injuries and headache characteristics, including time from injury to headache onset, detailed descriptions and International Classification of Headache Disorders second edition primary headache diagnosis type. Results A total of 95 soldiers reported 166 headaches. The most common injury cited was a blast (53.7%). Most subjects (76.8%) recalled the onset of any headache within 7 days of injury. The most commonly diagnosed headache was a continuous type with migraine features ( n = 31 (18.7%)), followed by chronic migraine (type 1.5.1, n = 14 (8.4%)), migraine with aura (type 1.2.1, n = 10 (6.0%)), hemicrania continua (type 4.7, n = 12 (7.2%)), chronic cluster (type 3.1.2, n = 6 (3.6%)) and headaches not otherwise classifiable (type 14.1, n = 5 (3.0%)) also present. The most clinically important was a continuous headache with migraine features. Conclusion We present a series of patients seen in a military treatment facility for headache diagnosis after concussion in whom we found migraine, as well as uncommon primary headache types, at frequencies that were much higher than expected.
authors.affiliation: 1 Womack Army Medical Center (WAMC), Fort Bragg, NC, USA.|2 Defense and Veterans Brain Injury Center, Silver Spring, MD, USA.|3 Carolina Headache Institute, Chapel Hill, NC, USA.
authors.forename: Alan G
authors.initials: AG
authors.lastname: Finkel
authors.affiliation: 1 Womack Army Medical Center (WAMC), Fort Bragg, NC, USA.
authors.forename: Juanita A
authors.initials: JA
authors.lastname: Yerry
authors.affiliation: 1 Womack Army Medical Center (WAMC), Fort Bragg, NC, USA.
authors.forename: John S
authors.initials: JS
authors.lastname: Klaric
authors.affiliation: 2 Defense and Veterans Brain Injury Center, Silver Spring, MD, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Ivins
authors.affiliation: 4 Uniformed Services University, Bethesda, MD, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Scher
authors.affiliation: 1 Womack Army Medical Center (WAMC), Fort Bragg, NC, USA.
authors.forename: Young S
authors.initials: YS
authors.lastname: Choi
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001753:Blast Injuries / Q000175:diagnosis / Q000453:epidemiology; D001924:Brain Concussion / Q000175:diagnosis* / Q000453:epidemiology; D015331:Cohort Studies; D003130:Combat Disorders / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006261:Headache / Q000145:classification* / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D054542:Iraq War, 2003-2011; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D012189:Retrospective Studies; D055815:Young Adult
keywords: Traumatic brain injury; chronic migraine; diagnosis; headache; migraine; military