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Lyons HS, Sassani M, Thaller M, Yiangou A, Grech O, Mollan SP, Wilson DR, Lucas SJE, Mitchell JL, Hill LJ, Sinclair AJ. Evaluating the Phenotypic Patterns of Post-Traumatic Headache: A Systematic Review of Military Personnel. Mil Med 2024:usae353. [PMID: 39028222 DOI: 10.1093/milmed/usae353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/20/2024] [Accepted: 07/10/2024] [Indexed: 07/20/2024] Open
Abstract
INTRODUCTION Mild traumatic brain injury (TBI) affects a significant number of military personnel, primarily because of physical impact, vehicle incidents, and blast exposure. Post-traumatic headache (PTH) is the most common symptom reported following mild TBI and can persist for several years. However, the current International Classification of Headache Disorders lacks phenotypic characterization for this specific headache disorder. It is important to appropriately classify the headache sub-phenotypes as it may enable more targeted management approaches. This systematic review seeks to identify the most common sub-phenotype of headaches in military personnel with PTH attributed to mild TBI. METHODS We conducted a systematic search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines, focusing on the military population. PubMed, Web of Science, Cochrane, and Clinicaltrials.gov databases were searched. Abstracts and full texts were independently reviewed by two authors using predefined inclusion and exclusion criteria. Data extraction was performed using a standardized form. The risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS Eight papers related to the military population were included in this review. Migraine was the most commonly reported headache sub-phenotype, with a prevalence ranging from 33 to 92%. Additionally, one military study identified tension-type headaches as the most prevalent headache phenotype. Although not the primary phenotype, one military cohort reported that approximately one-third of their cohort experienced trigeminal autonomic cephalalgias, which were associated with exposure to blast injuries and prior concussions. CONCLUSION This systematic review demonstrated that PTH in the military population frequently exhibit migraine-like features. Tension-type headache and trigeminal autonomic cephalalgias also occur, although less commonly reported. Sub-phenotyping PTH may be important for initiating effective treatment since different phenotypes may respond differently to medications. The study populations analyzed in this systematic review display heterogeneity, underscoring the necessity for additional research features, more stringent criteria and comprehensive recording of baseline characteristics. Characterizing headaches following injury is crucial for an accurate diagnosis to enable effective management and rehabilitation planning for our armed forces.
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Affiliation(s)
- Hannah S Lyons
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Department of Neurology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, UK
| | - Matilde Sassani
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Department of Neurology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, UK
| | - Mark Thaller
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Department of Neurology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, UK
| | - Andreas Yiangou
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Department of Neurology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, UK
| | - Olivia Grech
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Department of Neurology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, UK
| | - Susan P Mollan
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK
| | - Duncan R Wilson
- Defence Medical Directorate (Research & Clinical Innovation), HQ DMS Group, Lichfield WS14 9PY, UK
| | - Samuel J E Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Centre for Human Brain Health, University of Birmingham, Birmingham B15 2TT, UK
| | - James L Mitchell
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Department of Neurology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, UK
- Academic Department of Military Rehabilitation, Defense Medical Rehabilitation Centre, Stanford Hall, Loughborough LE12 5QW, UK
| | - Lisa J Hill
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- School of Biomedical Sciences, Institute of Clinical Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Alexandra J Sinclair
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Department of Neurology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, UK
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Scher AI, McGinley JS, VanDam LR, Campbell AM, Chai X, Collins B, Klimp SA, Finkel AG, Schwab K, Lipton RB, Johnson KW. Plasma calcitonin gene-related peptide and nerve growth factor as headache and pain biomarkers in recently deployed soldiers with and without a recent concussion. Headache 2023; 63:1240-1250. [PMID: 37796114 DOI: 10.1111/head.14635] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE The objective of this study was to characterize the utility of calcitonin gene-related peptide (CGRP) and nerve growth factor (NGF) as potential biomarkers for headache and pain disorders in the post-military deployment setting. BACKGROUND The need to improve recognition, assessment, and prognoses of individuals with posttraumatic headache or other pain has increased interest in the potential of CGRP and NGF as biomarkers. METHODS The Warrior Strong Study (NCT01847040) is an observational longitudinal study of United States-based soldiers who had recently returned from deployment to Afghanistan or Iraq from 2009 to 2014. The present nested cross-sectional analysis uses baseline data collected from soldiers returning to Fort Bragg, North Carolina. RESULTS In total, 264 soldiers (mean (standard deviation [SD] age 28.1 [6.4] years, 230/264 [87.1%] men, 171/263 [65.0%] White) were analyzed. Mean (SD) plasma levels of CGRP were 1.3 (1.1) pg/mL and mean levels of NGF were 1.4 (0.4) pg/mL. Age was negatively correlated with NGF (-0.01 pg/mL per year, p = 0.007) but was not associated with CGRP. Men had higher mean (SD) CGRP plasma levels than women (1.4 95% confidence interval [CI; 1.2] vs. 0.9 95% CI [0.5] pg/mL, p < 0.002, Kruskal-Wallis test). CGRP levels were lower in participants who had a headache at the time of the blood draw (1.0 [0.6] pg/mL vs. 1.4 [1.2] pg/mL, p = 0.024). NGF was lower in participants with continuous pain (all types; 1.2 [0.4] vs. 1.4 [0.4] pg/mL, p = 0.027) and was lower in participants with traumatic brain injury (TBI) + posttraumatic headache (PTH) versus TBI without PTH (1.3 [0.3] vs. 1.4 [0.4] pg/mL, p = 0.021). Otherwise, CGRP and NGF were not associated with migraine-like headache, TBI status, or headache burden as measured by the number of medical encounters in crude or adjusted models. CONCLUSION In this exploratory study, plasma levels of NGF and CGRP showed promise as biomarkers for headache and other types of pain. These findings need to be replicated in other cohorts.
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Affiliation(s)
- Ann I Scher
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | | | - Lyndsey R VanDam
- Pain Research, Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | - Xiyun Chai
- Precision Medicine Neuroscience, AbbVie, Chicago, Illinois, USA
| | - Billy Collins
- US Public Health Service Commissioned Corps, Fayetteville, North Carolina, USA
| | - Scott A Klimp
- Womack Army Medical Center, Fort Bragg, North Carolina, USA
| | - Alan G Finkel
- Carolina Headache Institute, Durham, North Carolina, USA
| | - Karen Schwab
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | | | - Kirk W Johnson
- Pain Research, Eli Lilly and Company, Indianapolis, Indiana, USA
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Nabity PS, Reed DE, McGeary CA, Houle TT, Jaramillo CA, Resick PA, Eapen BC, Litz BT, Mintz J, Penzien DB, Keane TM, Young-McCaughan S, Peterson AL, McGeary DD. Mechanisms of change in posttraumatic headache-related disability: A mediation model. Headache 2023; 63:410-417. [PMID: 36905163 DOI: 10.1111/head.14480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 03/12/2023]
Abstract
OBJECTIVE To explore whether the association between change in headache management self-efficacy and posttraumatic headache-related disability is partially mediated by a change in anxiety symptom severity. BACKGROUND Many cognitive-behavioral therapy treatments for headache emphasize stress management, which includes anxiety management strategies; however, little is currently known about mechanisms of change in posttraumatic headache-related disability. Increasing our understanding of mechanisms could lead to improvements in treatments for these debilitating headaches. METHODS This study is a secondary analysis of veterans (N = 193) recruited to participate in a randomized clinical trial of cognitive-behavioral therapy, cognitive processing therapy, or treatment as usual for persistent posttraumatic headache. The direct relationship between headache management self-efficacy and headache-related disability, along with partial mediation through change in anxiety symptoms was tested. RESULTS The mediated latent change direct, mediated, and total pathways were statistically significant. The path analysis supported a significant direct pathway between headache management self-efficacy and headache-related disability (b = -0.45, p < 0.001; 95% confidence interval [CI: -0.58, -0.33]). The total effect of change of headache management self-efficacy scores on change in Headache Impact Test-6 scores was significant with a moderate-to-strong effect (b = -0.57, p = 0.001; 95% CI [-0.73, -0.41]). There was also an indirect effect through anxiety symptom severity change (b = -0.12, p = 0.003; 95% CI [-0.20, -0.04]). CONCLUSIONS In this study, most of the improvements in headache-related disability were related to increased headache management self-efficacy with mediation occurring through change in anxiety. This indicates that headache management self-efficacy is a likely mechanism of change of posttraumatic headache-related disability with decreases in anxiety explaining part of the improvement in headache-related disability.
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Affiliation(s)
- Paul S Nabity
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science at San Antonio, San Antonio, Texas, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - David E Reed
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Cindy A McGeary
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science at San Antonio, San Antonio, Texas, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Timothy T Houle
- Department of Anesthesia, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Carlos A Jaramillo
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, Texas, USA
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Patricia A Resick
- Department of Psychiatry and Behavioral Sciences, Duke Health, Durham, North Carolina, USA
| | - Blessen C Eapen
- Department of Physical Medicine and Rehabilitation, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Division of Physical Medicine and Rehabilitation, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Brett T Litz
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science at San Antonio, San Antonio, Texas, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Donald B Penzien
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Terence M Keane
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science at San Antonio, San Antonio, Texas, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science at San Antonio, San Antonio, Texas, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Donald D McGeary
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science at San Antonio, San Antonio, Texas, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, Texas, USA
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA
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McDonald MA, Tayebi M, McGeown JP, Kwon EE, Holdsworth SJ, Danesh-Meyer HV. A window into eye movement dysfunction following mTBI: A scoping review of magnetic resonance imaging and eye tracking findings. Brain Behav 2022; 12:e2714. [PMID: 35861623 PMCID: PMC9392543 DOI: 10.1002/brb3.2714] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/11/2022] [Accepted: 05/23/2022] [Indexed: 12/01/2022] Open
Abstract
Mild traumatic brain injury (mTBI), commonly known as concussion, is a complex neurobehavioral phenomenon affecting six in 1000 people globally each year. Symptoms last between days and years as microstructural damage to axons and neurometabolic changes result in brain network disruption. There is no clinically available objective biomarker to diagnose the severity of injury or monitor recovery. However, emerging evidence suggests eye movement dysfunction (e.g., saccades and smooth pursuits) in patients with mTBI. Patients with a higher symptom burden and prolonged recovery time following injury may show higher degrees of eye movement dysfunction. Likewise, recent advances in magnetic resonance imaging (MRI) have revealed both white matter tract damage and functional network alterations in mTBI patients, which involve areas responsible for the ocular motor control. This scoping review is presented in three sections: Section 1 explores the anatomical control of eye movements to aid the reader with interpreting the discussion in subsequent sections. Section 2 examines the relationship between abnormal MRI findings and eye tracking after mTBI based on the available evidence. Finally, Section 3 communicates gaps in our knowledge about MRI and eye tracking, which should be addressed in order to substantiate this emerging field.
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Affiliation(s)
- Matthew A McDonald
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Mātai Medical Research Institute, Gisborne, New Zealand
| | - Maryam Tayebi
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Joshua P McGeown
- Mātai Medical Research Institute, Gisborne, New Zealand.,Auckland University of Technology Traumatic Brain Injury Network, Auckland, New Zealand
| | - Eryn E Kwon
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Mātai Medical Research Institute, Gisborne, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Samantha J Holdsworth
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Mātai Medical Research Institute, Gisborne, New Zealand.,Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Helen V Danesh-Meyer
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Eye Institute, Auckland, New Zealand
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5
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McGeary DD, Resick PA, Penzien DB, McGeary CA, Houle TT, Eapen BC, Jaramillo CA, Nabity PS, Reed DE, Moring JC, Bira LM, Hansen HR, Young-McCaughan S, Cobos BA, Mintz J, Keane TM, Peterson AL. Cognitive Behavioral Therapy for Veterans With Comorbid Posttraumatic Headache and Posttraumatic Stress Disorder Symptoms: A Randomized Clinical Trial. JAMA Neurol 2022; 79:746-757. [PMID: 35759281 PMCID: PMC9237802 DOI: 10.1001/jamaneurol.2022.1567] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Question Do cognitive behavioral therapies for posttraumatic headache and posttraumatic stress disorder (PTSD) symptoms improve headache-related disability in veterans compared with treatment per usual? Findings A randomized clinical trial of 193 post-9/11 combat veterans with posttraumatic headache and PTSD symptoms found headache disability was significantly improved with cognitive behavioral therapy for headaches compared with treatment per usual. Though participants randomly assigned to cognitive processing therapy reported significantly greater improvement in PTSD symptom severity compared with treatment per usual, there was no significant effect of cognitive processing therapy on headache disability. Meaning Cognitive behavioral therapies are efficacious treatments for veterans with comorbid posttraumatic headache and PTSD symptoms. Importance Posttraumatic headache is the most disabling complication of mild traumatic brain injury. Posttraumatic stress disorder (PTSD) symptoms are often comorbid with posttraumatic headache, and there are no established treatments for this comorbidity. Objective To compare cognitive behavioral therapies (CBTs) for headache and PTSD with treatment per usual (TPU) for posttraumatic headache attributable to mild traumatic brain injury. Design, Setting, and Participants This was a single-site, 3–parallel group, randomized clinical trial with outcomes at posttreatment, 3-month follow-up, and 6-month follow-up. Participants were enrolled from May 1, 2015, through May 30, 2019; data collection ended on October 10, 2019. Post-9/11 US combat veterans from multiple trauma centers were included in the study. Veterans had comorbid posttraumatic headache and PTSD symptoms. Data were analyzed from January 20, 2020, to February 2, 2022. Interventions Patients were randomly assigned to 8 sessions of CBT for headache, 12 sessions of cognitive processing therapy for PTSD, or treatment per usual for headache. Main Outcomes and Measures Co–primary outcomes were headache-related disability on the 6-Item Headache Impact Test (HIT-6) and PTSD symptom severity on the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PCL-5) assessed from treatment completion to 6 months posttreatment. Results A total of 193 post-9/11 combat veterans (mean [SD] age, 39.7 [8.4] years; 167 male veterans [87%]) were included in the study and reported severe baseline headache-related disability (mean [SD] HIT-6 score, 65.8 [5.6] points) and severe PTSD symptoms (mean [SD] PCL-5 score, 48.4 [14.2] points). For the HIT-6, compared with usual care, patients receiving CBT for headache reported −3.4 (95% CI, −5.4 to −1.4; P < .01) points lower, and patients receiving cognitive processing therapy reported −1.4 (95% CI, −3.7 to 0.8; P = .21) points lower across aggregated posttreatment measurements. For the PCL-5, compared with usual care, patients receiving CBT for headache reported −6.5 (95% CI, −12.7 to −0.3; P = .04) points lower, and patients receiving cognitive processing therapy reported −8.9 (95% CI, −15.9 to −1.9; P = .01) points lower across aggregated posttreatment measurements. Adverse events were minimal and similar across treatment groups. Conclusions and Relevance This randomized clinical trial demonstrated that CBT for headache was efficacious for disability associated with posttraumatic headache in veterans and provided clinically significant improvement in PTSD symptom severity. Cognitive processing therapy was efficacious for PTSD symptoms but not for headache disability. Trial Registration ClinicalTrials.gov Identifier: NCT02419131
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Affiliation(s)
- Donald D McGeary
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio.,Department of Rehabilitation Medicine, The University of Texas Health Science Center at San Antonio, San Antonio.,South Texas Veterans Health Care System, San Antonio.,Department of Psychology, The University of Texas at San Antonio, San Antonio
| | - Patricia A Resick
- Department of Psychiatry and Behavioral Sciences, Duke Health, Durham, North Carolina
| | - Donald B Penzien
- Departments of Psychiatry and Behavioral Medicine & Neurology, Wake Forest University, Winston-Salem, North Carolina
| | - Cindy A McGeary
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio.,South Texas Veterans Health Care System, San Antonio
| | - Timothy T Houle
- Department of Anesthesia, Massachusetts General Hospital, Boston
| | - Blessen C Eapen
- Greater Los Angeles Veterans Health Care System, Los Angeles, California.,Department of Physical Medicine and Rehabilitation, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
| | - Carlos A Jaramillo
- Department of Rehabilitation Medicine, The University of Texas Health Science Center at San Antonio, San Antonio.,South Texas Veterans Health Care System, San Antonio
| | - Paul S Nabity
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio.,South Texas Veterans Health Care System, San Antonio
| | - David E Reed
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio
| | - John C Moring
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio.,South Texas Veterans Health Care System, San Antonio
| | - Lindsay M Bira
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio
| | - Hunter R Hansen
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio.,South Texas Veterans Health Care System, San Antonio
| | - Briana A Cobos
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio.,Department of Psychology, The University of Texas at San Antonio, San Antonio
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio.,South Texas Veterans Health Care System, San Antonio
| | - Terence M Keane
- Behavioral Science Division, National Center for PTSD, Boston, Massachusetts.,VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio.,South Texas Veterans Health Care System, San Antonio.,Department of Psychology, The University of Texas at San Antonio, San Antonio
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Traumatic Brain Injury Temporal Lesion causing Hemicrania Continua. Can J Neurol Sci 2022:1-2. [DOI: 10.1017/cjn.2022.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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7
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Heir GM, DiPede L, Kuchukulla M, Kalladka M, Aziz S. Diagnosis and Management of Traumatically Induced Hemicrania Continua and Neuropathic Pain Secondary to Facial Gun Shot Wound. J Oral Rehabil 2022; 49:831-837. [PMID: 35347753 PMCID: PMC9544847 DOI: 10.1111/joor.13324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/12/2022] [Accepted: 03/21/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Gary M. Heir
- Clinic and Program Director Center for Temporomandibular Disorders and Orofacial Pain Rutgers school of dental medicine Newark New Jersey USA
| | - Louis DiPede
- Restorative Dentistry Kornberg School of Dentistry Temple University Philadelphia USA
| | - Manvitha Kuchukulla
- Private practice, former Chief Resident Post‐Graduate Program in Orofacial Pain, Center for Temporomandibular Disorders and Orofacial Pain, Rutgers School of Dental Medicine Newark New Jersey USA
| | - Mythili Kalladka
- Orofacial Pain and TMD Eastman Institute of Oral Health Rochester New York USA
| | - Shahad Aziz
- Department of Oral and Maxillofacial Surgery Rutgers School of Dental Medicine Newark New Jersey USA
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Kothari SF, Eggertsen PP, Frederiksen OV, Thastum MM, Svendsen SW, Tuborgh A, Næss-Schmidt ET, Rask CU, Schröder A, Kasch H, Nielsen JF. Characterization of persistent post-traumatic headache and management strategies in adolescents and young adults following mild traumatic brain injury. Sci Rep 2022; 12:2209. [PMID: 35140235 PMCID: PMC8828894 DOI: 10.1038/s41598-022-05187-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 12/20/2021] [Indexed: 11/18/2022] Open
Abstract
Characteristics of persistent post-traumatic headache (PTH) in young individuals are poorly known leading to diagnostic problems and diverse management. We aimed to describe headache phenotypes and self-reported management strategies in young individuals with PTH following mild traumatic brain injury (mTBI). A comprehensive structured questionnaire was used to evaluate headache phenotypes/characteristics and management strategies to relieve headache in 107, 15–30-year-old individuals with PTH. Around 4 months post-injury, migraine-like headache in combination with tension-type like headache (40%) was the most commonly encountered headache phenotype followed by migraine-like headache (36%). Around 50% reported aura-like symptoms before/during the headache attack. Medication-overuse headache was diagnosed in 10%. Stress, sleep disturbances, and bright lights were the most common trigger factors. More than 80% reported that their headache was worsened by work-related activity and alleviated by rest/lying down. Simple analgesics were commonly used (88%) whereas prophylactic drugs were rarely used (5%). Bedrest and physiotherapy were also commonly used as management strategies by 56% and 34% of the participants, respectively. In conclusion, most young individuals with PTH after mTBI presented with combined migraine-like and tension-type-like headache followed by migraine-like headache, only. Preventive headache medication was rarely used, while simple analgesics and bedrest were commonly used for short-term headache relief.
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Affiliation(s)
- Simple Futarmal Kothari
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark. .,Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Boulevard 9, 8000, Aarhus C, Denmark. .,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.
| | | | | | | | - Susanne Wulff Svendsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark.,Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, Section of Environmental Health, University of Copenhagen, Copenhagen, Denmark
| | - Astrid Tuborgh
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | | | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andreas Schröder
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Helge Kasch
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Regional Hospital of Viborg, Viborg, Denmark
| | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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MacGregor AJ, Shannon KB, Dougherty AL. Time Since Injury as a Factor in Post-Concussion Symptom Reporting among Military Service Members with Blast-Related Concussion. J Neurotrauma 2021; 38:2447-2453. [PMID: 33906380 DOI: 10.1089/neu.2020.7334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Over the last decade, much research has been devoted to concussion among military personnel. Post-concussion symptoms after blast-related concussion are common, but it is unknown whether symptom reporting differs over time. This study's objective was to assess the relationship between time since injury and post-concussion symptom reporting. We conducted a retrospective review of existing records to identify service members who experienced blast-related concussion during deployment between 2007 and 2012 and who responded to a Post-Deployment Health Assessment (PDHA). The study population included 3690 military personnel grouped by time between injury and PDHA completion: 1-90 days (45.3%, n = 1,673), 91-180 days (33.0%, n = 1,216), or 181-365 days (21.7%, n = 801). Post-concussion symptoms assessed on the PDHA included headache, tinnitus, memory problems, concentration problems, difficulty making decisions, irritability, dizziness, and sleep problems. All post-concussion symptoms were higher for 91-180 days and 181-365 days after injury relative to 1-90 days, with the exception of dizziness. After adjustment for loss of consciousness, mental health comorbidity, and other covariates, the odds of reporting three or more post-concussion symptoms were significantly higher in those who completed the PDHA 91-180 days (odds ratio: 1.29; 95% confidence interval: 1.09-1.51) or 181-365 days after injury (odds ratio: 1.33; 95% confidence interval: 1.09-1.61), compared with the 1-90 days group. These findings suggest that refinements to in-theater medical care may be needed to reduce post-concussion symptom burden and improve the prospect of concussion recovery.
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Affiliation(s)
- Andrew J MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
| | - Kaeley B Shannon
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
- Axiom Resource Management, Inc., San Diego, California, USA
| | - Amber L Dougherty
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc., San Diego, California, USA
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Prakash S, Rawat KS. Hemicrania Continua: An Update. Neurol India 2021; 69:S160-S167. [PMID: 34003161 DOI: 10.4103/0028-3886.315976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Hemicrania continua (HC) is not uncommon in clinical practice, and several large case series have been published in the recent past. Objectives This review provides an overview of the recent advancement in different aspects of HC. Methods We reviewed the articles published on HC in the last 2 decades. Results HC constitutes 1.7% of patients with headache in the clinics. It presents with unilateral continuous background pain with periodic exacerbations, usually accompanied by cranial autonomic features and restlessness. The continuous background headache is the most consistent and central feature of HC. Although the duration of exacerbations varies from a few seconds to a few weeks, the frequency ranges from >20 attacks/day to one attack in several months. The background pain is mild to moderate in intensity and does not hamper routine activity. Patients and physicians frequently ignore the basal pain, and a case of HC is misdiagnosed as other headaches, depending on the pattern of exacerbations. The exacerbation mimics several primary headaches and neuralgias. There are about 75 cases of secondary HC, due to 29 different pathologies. Although an absolute response to indomethacin is part of the diagnostic criteria, a subset of patients may respond to several other drugs. Headache reappears immediately on skipping a single dose of effective drug. Several surgical procedures have been tried in patients who are intolerant to indomethacin. Conclusion Misdiagnosis of HC is common. Continuous background pain and response to indomethacin are two essential features for the diagnosis of HC.
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Affiliation(s)
- Sanjay Prakash
- Department of Neurology, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, Gujarat, India
| | - Kalu Singh Rawat
- Department of Neurology, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, Gujarat, India
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11
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Normative values for the Sensory Organization Test in an active duty military cohort. Gait Posture 2021; 85:31-37. [PMID: 33513530 DOI: 10.1016/j.gaitpost.2021.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Computerized dynamic posturography is commonly used to assess balance in service members, but normative values for the military population have not been established. RESEARCH QUESTION What are the normative values for the Motor Control Test (MCT), Sensory Organization Test (SOT) and the enhanced SOT (eSOT) within the military population and at which point do they differ? METHODS Cross-sectional study. 237 active duty service members (78 % male) completed the MCT, SOT and the eSOT with the sway manipulated at a gain of 1.2, 1.4, 1.6, 1.8, or 2.0. A Mann-Whitney U test was used to compare the means of men and women for the SOT and MCT composite scores. A Kruskal-Wallis H test was used to compare the means of age groups for the SOT composite score. An independent t-test was used to compare the SOT composite scores from our military population to the manufacturer's normative (civilian) data. The means and standard deviations for the eSOT scores were reported for each gain. Paired-samples t-tests were performed to compare the SOT composite score with the eSOT composite score for each level of gain. RESULTS There was no difference between SOT composite scores for men and women (Mann-Whitney U = 4363.50, p = 0.19) or among age groups (Kruskal-Wallis = 2.77, p = 0.25). The mean SOT composite scores were not different from the manufacturer's normative values (p = 0.155). SOT composite scores were significantly higher than eSOT composite scores for gains of 1.4 (t = 3.16, p = 0.003), 1.6 (t = 5.73, p < 0.001), 1.8 (t = 5.26, p < 0.001) and 2.0 (t = 5.89, p < 0.001). MCT composite scores were lower in the 18-26 year old than the 36-45 year old age group (p = 0.013). SIGNIFICANCE This study establishes normative values for the MCT, SOT and eSOT in active duty military service members. The results suggest that the manufacturer's normal values are appropriate for making judgments about the postural stability of service members.
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12
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Scher AI, McGinley JS, Wirth RJ, Lipton RB, Terrio H, Brenner LA, Cole WR, Schwab K. Headache complexity (number of symptom features) differentiates post-traumatic from non-traumatic headaches. Cephalalgia 2020; 41:582-592. [PMID: 33242991 DOI: 10.1177/0333102420974352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Post-traumatic headaches are a common sequela of mild traumatic brain injury (concussion). It is unclear whether or how these headaches differ phenotypically from primary headaches. OBJECTIVE Determine whether there is an overarching unobserved latent trait that drives the expression of observed features of post-traumatic headache and other headaches. METHODS Data from this post-hoc analysis come from the Warrior Strong Cohort Study conducted from 2010 through 2015. Approximately 25,000 soldiers were screened for concussion history at routine post-deployment health assessments. A random sample was invited to participate, enrolling 1567. Twelve observed headache phenotypic features were used to measure "headache complexity", the latent trait of clinical interest, using single factor confirmatory factor analysis. We compared headache complexity between groups and determined whether headache complexity predicted accessing medical care for headache. RESULTS Of 1094 soldiers with headaches, 198 were classified as having post-traumatic headache. These headaches were compared to those in the other soldiers (647 without concussion history and 249 with concussion history). Soldiers with post-traumatic headache had greater endorsement of all 12 headache features compared to the soldiers with non-concussive headaches. The confirmatory factor analysis showed good model fit (χ2 (51) = 95.59, p = 0.0002, RMSEA = 0.03, comparative fit index = 0.99, and Tucker-Lewis index = 0.99), providing empirical support for the headache complexity construct. Soldier groups differed in their mean headache complexity level (p < 0.001) such that post-traumatic headache soldiers had greater headache complexity compared to non-concussed soldiers (standardized mean difference = 0.91, 95% confidence interval: 0.72-1.09, p < 0.001 and to concussed soldiers with coincidental headaches standardized mean difference = 0.75, 95% confidence interval: 0.53-0.96, p < 0.001). Increasing headache complexity predicted medical encounters for headache (odds ratio = 1.87, 95% confidence interval: 1.49-2.35, p < 0.001) and migraine (odds ratio = 3.74, 95% confidence interval: 2.33-5.98, p < 0.001) during the year following deployment.Conclusions and relevance: The current study provided support for a single latent trait, characterized by observed headache symptoms, that differentiates between concussive and non-concussive headaches and predicts use of medical care for headache. The single trait confirmatory factor analysis suggests that post-traumatic headaches differ from non-concussive headaches by severity more than kind, based on the symptoms assessed.ClinicalTrials.gov identifier NCT01847040.
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Affiliation(s)
- Ann I Scher
- 1685Uniformed Services University, Bethesda, MD, USA
| | | | - R J Wirth
- Vector Psychometric Group, LLC, Chapel Hill, NC, USA
| | | | - Heidi Terrio
- 19909Evans Army Community Hospital, Colorado Springs, CO, USA.,VA (Veterans Affairs) Puget Sound Health System, Seattle, WA, USA
| | - Lisa A Brenner
- Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,VA (Veterans Affairs) Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA
| | - Wesley R Cole
- Intrepid Spirit Center, 19921Womack Army Medical Center, Fort Bragg, NC, USA
| | - Karen Schwab
- 1685Uniformed Services University, Bethesda, MD, USA
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13
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Remigio-Baker RA, Kiser S, Ferdosi H, Gregory E, Engel S, Sebesta S, Beauchamp D, Malik S, Scher A, Hinds SR. Provider Training in the Management of Headache Following Concussion Clinical Recommendation: Promoting a Standardized Means for Efficient Patient Recovery and Timely Return to Duty. Front Neurol 2020; 11:559311. [PMID: 33178105 PMCID: PMC7593659 DOI: 10.3389/fneur.2020.559311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/26/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Headache is a common symptom reported following concussion/mild traumatic brain injury. The Department of Defense's clinical recommendation (CR) describes guidance for primary care providers for the management of post-traumatic headache (PTH) in Service members. Objective: The objective of this study is to examine the association between training on the CR with provider clinical practice, patient behaviors, and symptom recovery. Methods: Participants were healthcare providers and two patient groups (one receiving care as usual [CAU] and another receiving care after provider training on PTH CR [CR+]). Providers were interviewed at three time points: (1) prior to CAU enrollment; (2) after CAU enrollment, but prior to training; and (3) after CR+ follow-up. Data from the second and third provider interview were used to evaluate a potential difference between provider practices pre- and post-training (n = 13). Patients were enrolled within 6 months of concussion. Patient outcomes (including neurobehavioral and headache symptoms) were assessed at three time-points: within 72 h (n = 35), at 1-week (n = 34) and at 1-month post-enrollment (n = 27). Results: Most follow-up care reported by providers were recommended within 72 h of initial visit post-training vs. >1 week pre-training. Additionally, providers reported a greater number of visits based on patient symptoms after training than before. Post-training, most providers reported referring patients to higher level of care “as needed,” if not “very rarely,” compared to 25% reported referrals prior to training. At 1-week post-enrollment the CR+ patient group reported more frequent medical provider visits compared to the CAU group. This trend was reversed at the 1-month follow-up whereby more CAU reported seeing a medical provider compared to CR+. By 1-week post-enrollment, fewer patients in the CR+ group reported being referred to any other providers or specialists compared to the CAU group. No differences in patient outcomes by provider training was found. Conclusion: The study results demonstrate the feasibility of training on the Management of Headache Following Concussion CR in order to change provider practices by promoting timely care, and promoting patient compliance as shown through improvement in follow-up visits and more monitoring within the primary care clinic.
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Affiliation(s)
- Rosemay A Remigio-Baker
- Defense and Veterans Brain Injury Center, Silver Spring, MD, United States.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States.,Naval Hospital Camp Pendleton, Camp Pendleton, CA, United States
| | - Seth Kiser
- Defense and Veterans Brain Injury Center, Silver Spring, MD, United States.,General Dynamics Information Technology, Falls Church, VA, United States
| | - Hamid Ferdosi
- Defense and Veterans Brain Injury Center, Silver Spring, MD, United States.,General Dynamics Information Technology, Falls Church, VA, United States
| | - Emma Gregory
- Defense and Veterans Brain Injury Center, Silver Spring, MD, United States
| | - Scot Engel
- Fort Hood Intrepid Spirit Center, Fort Hood, TX, United States
| | - Sean Sebesta
- Fort Bliss Intrepid Spirit Center, Fort Bliss, TX, United States
| | - Daniel Beauchamp
- Fort Bliss Intrepid Spirit Center, Fort Bliss, TX, United States
| | - Saafan Malik
- Defense and Veterans Brain Injury Center, Silver Spring, MD, United States
| | - Ann Scher
- Uniformed Services University, Bethesda, MD, United States
| | - Sidney R Hinds
- Uniformed Services University, Bethesda, MD, United States
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Phipps H, Mondello S, Wilson A, Dittmer T, Rohde NN, Schroeder PJ, Nichols J, McGirt C, Hoffman J, Tanksley K, Chohan M, Heiderman A, Abou Abbass H, Kobeissy F, Hinds S. Characteristics and Impact of U.S. Military Blast-Related Mild Traumatic Brain Injury: A Systematic Review. Front Neurol 2020; 11:559318. [PMID: 33224086 PMCID: PMC7667277 DOI: 10.3389/fneur.2020.559318] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/08/2020] [Indexed: 12/27/2022] Open
Abstract
As a result of armed conflict, head trauma from exposure to blasts is an increasing critical health issue, particularly among military service members. Whilst numerous studies examined the burden of blast-related brain injuries on service members', few systematic reviews have been published. This work provides a comprehensive summary of the evidence on blast-related mild traumatic brain injury (mTBI) burden in active U.S. military service members and inactive Veterans, describing characteristics and outcomes. Records published up to April 2017 were identified through a search of PubMed, Web of Science, Scopus, Ovid MEDLINE, and Cochrane Library. Records-based and original research reporting on U.S. military service members and Veterans with mild blast TBI were included. Data on subject characteristics, exposure, diagnostic criterion, and outcomes were extracted from included studies using a standardized extraction form and were presented narratively. Of the 2,290 references identified by the search, 106 studies with a total of 37,515 participants met inclusion criteria for blast-related mTBI. All but nine studies were based out of military or Veteran medical facilities. Unsurprisingly, men were over-represented (75–100%). The criteria used to define blast-related mTBI were consistent; however, the methodology used to ascertain whether individuals met those criteria for diagnosis were inconsistent. The diagnosis, most prevalent among the Army, heavily relied on self-reported histories. Commonly reported adverse outcomes included hearing disturbances and headaches. The most frequently associated comorbidities were post-traumatic stress disorder, depression, anxiety, sleep disorders, attention disorders, and cognitive disorders. The primary objective of this review was to provide a summary of descriptive data on blast-related mTBI in a U.S. military population. Low standardization of the methods for reaching diagnosis and problems in the study reporting emphasize the importance to collect high-quality data to fill knowledge gaps pertaining to blast-related mTBI.
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Affiliation(s)
- Helen Phipps
- Booz Allen Hamilton, San Antonio, TX, United States
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.,Department of Neurology IC, Oasi Research Institute-IRCCS, Troina, Italy
| | | | | | | | | | | | | | | | | | | | | | - Hussein Abou Abbass
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Firas Kobeissy
- Department of Psychiatry, Center for Neuroproteomics and Biomarkers Research, University of Florida, Gainesville, FL, United States
| | - Sidney Hinds
- Medical Research and Development Command, Ft Detrick, MD, United States
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15
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16
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Ibrahim O, Sutherland HG, Maksemous N, Smith R, Haupt LM, Griffiths LR. Exploring Neuronal Vulnerability to Head Trauma Using a Whole Exome Approach. J Neurotrauma 2020; 37:1870-1879. [PMID: 32233732 PMCID: PMC7462038 DOI: 10.1089/neu.2019.6962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Brain injuries are associated with oxidative stress and a need to restore neuronal homeostasis. Mutations in ion channel genes, in particular CACNA1A, have been implicated in familial hemiplegic migraine (FHM) and in the development of concussion-related symptoms in response to trivial head trauma. The aim of this study was to explore the potential role of variants in other ion channel genes in the development of such responses. We conducted whole exome sequencing (WES) on16 individuals who developed a range of neurological and concussion-related symptoms following minor or trivial head injuries. All individuals were initially tested and shown to be negative for mutations in known FHM genes. Variants identified from the WES results were filtered to identify rare variants (minor allele frequency [MAF] <0.01) in genes related to neural processes as well as genes highly expressed in the brain using a combination of in silico prediction tools (SIFT, PolyPhen, PredictSNP, Mutation Taster, and Mutation Assessor). Rare (MAF <0.001) or novel heterozygous variants in 7 ion channel genes were identified in 37.5% (6/16) of the cases (CACNA1I, CACNA1C, ATP10A, ATP7B, KCNAB1, KCNJ10, and SLC26A4), rare variants in neurotransmitter genes were found in 2 cases (GABRG1 and GRIK1), and rare variants in 3 ubiquitin-related genes identified in 4 cases (SQSTM1, TRIM2, and HECTD1). In this study, the largest proportion of potentially pathogenic variants in individuals with severe responses to minor head trauma were identified in genes previously implicated in migraine and seizure-related autosomal recessive neurological disorders. Together with results implicating variants in the hemiplegic migraine genes, CACNA1A and ATP1A2, in severe head trauma response, our results support a role for heterozygous deleterious mutations in genes implicated in neurological dysfunction and potentially increasing the risk of poor response to trivial head trauma.
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Affiliation(s)
- Omar Ibrahim
- Genomics Research Centre, Institute of Health and Biomedical Innovation, School of Biomedical Science, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia
| | - Heidi G Sutherland
- Genomics Research Centre, Institute of Health and Biomedical Innovation, School of Biomedical Science, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia
| | - Neven Maksemous
- Genomics Research Centre, Institute of Health and Biomedical Innovation, School of Biomedical Science, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia
| | - Robert Smith
- Genomics Research Centre, Institute of Health and Biomedical Innovation, School of Biomedical Science, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia
| | - Larisa M Haupt
- Genomics Research Centre, Institute of Health and Biomedical Innovation, School of Biomedical Science, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia
| | - Lyn R Griffiths
- Genomics Research Centre, Institute of Health and Biomedical Innovation, School of Biomedical Science, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia
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Moore BA, Hale WJ, Nabity PS, Koehn TR, McGeary D, Peterson AL. A Retrospective, Epidemiological Review of Hemiplegic Migraines in a Military Population. Mil Med 2020; 184:781-787. [PMID: 30877794 DOI: 10.1093/milmed/usz040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/28/2019] [Accepted: 02/20/2019] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Headaches are one of the world's most common disabling conditions. They are also both highly prevalent and debilitating among military personnel and can have a significant impact on fitness for duty. Hemiplegic migraines are an uncommon, yet severely incapacitating, subtype of migraine with aura for which there has been a significant increase amongst US military personnel over the past decade. To date, there has not been a scientific report on hemiplegic migraine in United States military personnel. MATERIALS AND METHODS The aim of this study was to provide an overview of hemiplegic migraine, to analyze data on the incidence of hemiplegic migraine in US military service members, and to evaluate demographic factors associated with hemiplegic migraine diagnoses. First time diagnoses of hemiplegic migraine were extracted from the Defense Medical Epidemiological Database according to ICD-9 and ICD-10 codes for hemiplegic migraine. One sample Chi-Square goodness of fit tests were conducted on weighted demographic samples to determine whether significant proportional differences existed between gender, age, military grade, service component, race, and marital status. RESULTS From 1997 to 2007 there were no cases of hemiplegic migraine recorded in the Defense Medical Epidemiological Database. However, from 2008 to 2017 there was a significant increase in the number of initial diagnoses of hemiplegic migraine, from 4 in 2008 to a high of 101 in 2016. From 2008 to 2017, 597 new cases of hemiplegic migraine were reported among US military service members. Disproportional incidence of hemiplegic migraine was observed for gender, X2 (1, 597) = 297.37, p <.001, age, X2 (5, 597) = 62.60, p <.001, service component, X2 (3, 597) = 31.48, p <.001, pay grade X2 (3, 597) = 57.96, p <.001, and race, X2 (2, 597) = 37.32, p <.001, but not for marital status X2 (1, 597) = 2.57, p >.05. CONCLUSION Over the past decade, there has been a significant increase in the number of initial diagnoses of hemiplegic migraine in Active Duty United States military personnel. Based on these diagnosis rates, there is evidence to suggest that hemiplegic migraine has a higher incidence and prevalence rate among post 9/11 service members of the United States military as compared to the general population. Given the sudden increase in new patients diagnosed with hemiplegic migraine in the past decade, the global prevalence estimates of hemiplegic migraine should be reconsidered. Additionally, the impact of hemiplegic migraine on service member's duties and responsibilities deserves further consideration.
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Affiliation(s)
- Brian A Moore
- University of Texas at San Antonio, One UTSA Circle, San Antonio, TX.,University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX
| | - Willie J Hale
- University of Texas at San Antonio, One UTSA Circle, San Antonio, TX
| | - Paul S Nabity
- University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX
| | - Tyler R Koehn
- Brooke Army Medical Center, Department of Neurology, 3551 Roger Brooke Drive, Fort Sam Houston JBSA, TX
| | - Donald McGeary
- University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX
| | - Alan L Peterson
- University of Texas at San Antonio, One UTSA Circle, San Antonio, TX.,University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX.,South Texas Veterans Health Care System, 7400 Merton Minter Boulevard, San Antonio, TX
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18
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Grangeon L, O'Connor E, Chan CK, Akijian L, Pham Ngoc TM, Matharu MS. New insights in post-traumatic headache with cluster headache phenotype: a cohort study. J Neurol Neurosurg Psychiatry 2020; 91:572-579. [PMID: 32381638 PMCID: PMC7279192 DOI: 10.1136/jnnp-2019-322725] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To define the characteristics of post-traumatic headache with cluster headache phenotype (PTH-CH) and to compare these characteristics with primary CH. METHODS A retrospective study was conducted of patients seen between 2007 and 2017 in a headache centre and diagnosed with PTH-CH that developed within 7 days of head trauma. A control cohort included 553 patients with primary CH without any history of trauma who attended the headache clinic during the same period. Data including demographics, attack characteristics and response to treatments were recorded. RESULTS Twenty-six patients with PTH-CH were identified. Multivariate analysis revealed significant associations between PTH-CH and family history of CH (OR 3.32, 95% CI 1.31 to 8.63), chronic form (OR 3.29, 95% CI 1.70 to 6.49), parietal (OR 14.82, 95% CI 6.32 to 37.39) or temporal (OR 2.04, 95% CI 1.10 to 3.84) location of pain, and presence of prominent cranial autonomic features during attacks (miosis OR 11.24, 95% CI 3.21 to 41.34; eyelid oedema OR 5.79, 95% CI 2.57 to 13.82; rhinorrhoea OR 2.65, 95% CI 1.26 to 5.86; facial sweating OR 2.53, 95% CI 1.33 to 4.93). Patients with PTH-CH were at a higher risk of being intractable to acute (OR 12.34, 95% CI 2.51 to 64.73) and preventive (OR 16.98, 95% CI 6.88 to 45.52) treatments and of suffering from associated chronic migraine (OR 10.35, 95% CI 3.96 to 28.82). CONCLUSION This largest series of PTH-CH defines it as a unique entity with specific evolutive profile. Patients with PTH-CH are more likely to suffer from the chronic variant, have marked autonomic features, be intractable to treatment and have associated chronic migraine compared with primary CH.
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Affiliation(s)
- Lou Grangeon
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, London, UK.,Department of Neurology, University Hospital Centre Rouen, Rouen, Normandie, France
| | - Emer O'Connor
- Department of Molecular Neuroscience, UCL Queen Square Institute of Neurology, London, UK
| | - Chun-Kong Chan
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, London, UK
| | - Layan Akijian
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, London, UK
| | - Thanh Mai Pham Ngoc
- Mathematics Institute of Orsay, Paris-Sud University, CNRS and Paris-Saclay University, Orsay, Île-de-France, France
| | - Manjit Singh Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, London, UK .,Headache and Facial Pain Group, The National Hospital for Neurology and Neurosurgery, London, UK
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Metti A, Schwab K, Finkel A, Pazdan R, Brenner L, Cole W, Terrio H, Scher AI. Posttraumatic vs nontraumatic headaches: A phenotypic analysis in a military population. Neurology 2020; 94:e1137-e1146. [PMID: 31924681 DOI: 10.1212/wnl.0000000000008935] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 09/12/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To describe and compare phenotypic features of posttraumatic headaches (PTH) and headaches unrelated to concussion. METHODS Participants are a random sample of recently deployed soldiers from the Warrior Strong cohort, consisting of soldiers with (n = 557) and without (n = 1,030) a history of a recent mild traumatic brain injury (mTBI; concussion). mTBI+ soldiers were subdivided as PTH+ (n = 230) and PTH- (n = 327). Headache classification was based on a detailed phenotypic questionnaire. Medical encounters for headache were documented for the year after deployment. RESULTS The findings here are limited to the soldiers with headaches, consisting of 94% of the mTBI+ soldiers and 76% of the mTBI- soldiers. Other than headache duration, all headache/migraine features were more common or more severe in the PTH+ group compared to the nonconcussed group (mTBI-) and compared to the concussed group with nontraumatic headaches (PTH-). Headaches were largely similar in the mTBI- and PTH- groups. The features most specific to PTH+ included allodynia, visual aura, sensory aura, daily headache, and continuous headache. Medical consultation for headache was most common in the PTH+ group (62%) vs the PTH- group (20%) or the mTBI- group (13%) (p < 0.008). CONCLUSIONS In this cohort of recently deployed soldiers, PTHs are more severe, frequent, and migraine-like and more often associated with medical consultation compared to headaches presumed unrelated to concussion. Future observational studies are needed to verify and characterize the PTH phenotype, which could be followed by treatment trials with appropriate and possibly novel outcomes for prespecified subgroups. CLINICALTRIALSGOV IDENTIFIER NCT01847040.
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Affiliation(s)
- Andrea Metti
- From the Metti Consulting Company (A.M.), Pittsburgh, PA; Defense and Veterans Brain Injury Center (K.S., A.F., R.P.), Silver Spring, MD; 9Line, LLC (K.S.), Tampa, FL; Carolina Headache Institute (A.F.), Durham, NC; Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology (L.B.), Anschutz Medical Campus, University of Colorado Aurora; Marcus Institute for Brain Health (L.B.), Aurora; VHA Rocky Mountain Mental Illness Research Education and Clinical Center (L.B.), Denver, CO; Womack Army Medical Center (A.F., W.C.), Fort Bragg, NC; Evans Army Community Hospital (H.T.), Colorado Springs, CO; and Uniformed Services University of the Health Sciences (A.I.S.), Bethesda MD
| | - Karen Schwab
- From the Metti Consulting Company (A.M.), Pittsburgh, PA; Defense and Veterans Brain Injury Center (K.S., A.F., R.P.), Silver Spring, MD; 9Line, LLC (K.S.), Tampa, FL; Carolina Headache Institute (A.F.), Durham, NC; Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology (L.B.), Anschutz Medical Campus, University of Colorado Aurora; Marcus Institute for Brain Health (L.B.), Aurora; VHA Rocky Mountain Mental Illness Research Education and Clinical Center (L.B.), Denver, CO; Womack Army Medical Center (A.F., W.C.), Fort Bragg, NC; Evans Army Community Hospital (H.T.), Colorado Springs, CO; and Uniformed Services University of the Health Sciences (A.I.S.), Bethesda MD
| | - Alan Finkel
- From the Metti Consulting Company (A.M.), Pittsburgh, PA; Defense and Veterans Brain Injury Center (K.S., A.F., R.P.), Silver Spring, MD; 9Line, LLC (K.S.), Tampa, FL; Carolina Headache Institute (A.F.), Durham, NC; Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology (L.B.), Anschutz Medical Campus, University of Colorado Aurora; Marcus Institute for Brain Health (L.B.), Aurora; VHA Rocky Mountain Mental Illness Research Education and Clinical Center (L.B.), Denver, CO; Womack Army Medical Center (A.F., W.C.), Fort Bragg, NC; Evans Army Community Hospital (H.T.), Colorado Springs, CO; and Uniformed Services University of the Health Sciences (A.I.S.), Bethesda MD
| | - Renee Pazdan
- From the Metti Consulting Company (A.M.), Pittsburgh, PA; Defense and Veterans Brain Injury Center (K.S., A.F., R.P.), Silver Spring, MD; 9Line, LLC (K.S.), Tampa, FL; Carolina Headache Institute (A.F.), Durham, NC; Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology (L.B.), Anschutz Medical Campus, University of Colorado Aurora; Marcus Institute for Brain Health (L.B.), Aurora; VHA Rocky Mountain Mental Illness Research Education and Clinical Center (L.B.), Denver, CO; Womack Army Medical Center (A.F., W.C.), Fort Bragg, NC; Evans Army Community Hospital (H.T.), Colorado Springs, CO; and Uniformed Services University of the Health Sciences (A.I.S.), Bethesda MD
| | - Lisa Brenner
- From the Metti Consulting Company (A.M.), Pittsburgh, PA; Defense and Veterans Brain Injury Center (K.S., A.F., R.P.), Silver Spring, MD; 9Line, LLC (K.S.), Tampa, FL; Carolina Headache Institute (A.F.), Durham, NC; Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology (L.B.), Anschutz Medical Campus, University of Colorado Aurora; Marcus Institute for Brain Health (L.B.), Aurora; VHA Rocky Mountain Mental Illness Research Education and Clinical Center (L.B.), Denver, CO; Womack Army Medical Center (A.F., W.C.), Fort Bragg, NC; Evans Army Community Hospital (H.T.), Colorado Springs, CO; and Uniformed Services University of the Health Sciences (A.I.S.), Bethesda MD
| | - Wesley Cole
- From the Metti Consulting Company (A.M.), Pittsburgh, PA; Defense and Veterans Brain Injury Center (K.S., A.F., R.P.), Silver Spring, MD; 9Line, LLC (K.S.), Tampa, FL; Carolina Headache Institute (A.F.), Durham, NC; Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology (L.B.), Anschutz Medical Campus, University of Colorado Aurora; Marcus Institute for Brain Health (L.B.), Aurora; VHA Rocky Mountain Mental Illness Research Education and Clinical Center (L.B.), Denver, CO; Womack Army Medical Center (A.F., W.C.), Fort Bragg, NC; Evans Army Community Hospital (H.T.), Colorado Springs, CO; and Uniformed Services University of the Health Sciences (A.I.S.), Bethesda MD
| | - Heidi Terrio
- From the Metti Consulting Company (A.M.), Pittsburgh, PA; Defense and Veterans Brain Injury Center (K.S., A.F., R.P.), Silver Spring, MD; 9Line, LLC (K.S.), Tampa, FL; Carolina Headache Institute (A.F.), Durham, NC; Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology (L.B.), Anschutz Medical Campus, University of Colorado Aurora; Marcus Institute for Brain Health (L.B.), Aurora; VHA Rocky Mountain Mental Illness Research Education and Clinical Center (L.B.), Denver, CO; Womack Army Medical Center (A.F., W.C.), Fort Bragg, NC; Evans Army Community Hospital (H.T.), Colorado Springs, CO; and Uniformed Services University of the Health Sciences (A.I.S.), Bethesda MD
| | - Ann I Scher
- From the Metti Consulting Company (A.M.), Pittsburgh, PA; Defense and Veterans Brain Injury Center (K.S., A.F., R.P.), Silver Spring, MD; 9Line, LLC (K.S.), Tampa, FL; Carolina Headache Institute (A.F.), Durham, NC; Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology (L.B.), Anschutz Medical Campus, University of Colorado Aurora; Marcus Institute for Brain Health (L.B.), Aurora; VHA Rocky Mountain Mental Illness Research Education and Clinical Center (L.B.), Denver, CO; Womack Army Medical Center (A.F., W.C.), Fort Bragg, NC; Evans Army Community Hospital (H.T.), Colorado Springs, CO; and Uniformed Services University of the Health Sciences (A.I.S.), Bethesda MD.
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Pohl H, Schubring-Giese M, Gantenbein AR. Can Anything Good Ever Come From Bearing Migraine Attacks? Suggestions for a Comprehensive Concept of Gain in Migraine. Curr Pain Headache Rep 2019; 23:90. [PMID: 31734850 DOI: 10.1007/s11916-019-0829-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarise the current state of knowledge concerning known types of gain, the reasons why patients might seek it, as well as implications for headache disorders. RECENT FINDINGS Even though the subject has been studied in the past, it received less attention in recent years. There is no doubt that migraine is a highly disabling disorder. However, attacks sometimes may be beneficial for the migraine brain as a time-out from the daily routine. On the other hand, patients are often stigmatised as trying to satisfy other needs through their disease. These "other needs" may be the exaggerated seeking for attention and affection or an undue official sickness certificate and were named secondary gain. Striving for secondary gain denotes a behaviour that aims at benefiting from a disease in a way that is seen as inappropriate by others. The fact that the term has persisted in doctors' vocabulary for decades probably indicates that it designates a concept considered relevant by many. However, its usage is complicated by its usually imprecise definition. We found in a literature search that the strive for secondary gain is not limited to neurosis, might both occur consciously and unconsciously, sometimes may aim at financial gain and sometimes at social gain, and can either be potentially expected or readily obtained. This behaviour mainly seems to aim at shaping one's interactions with the environment. Its causes have not been elucidated completely, though, but "unrequited demands for love, attention and affection" have been postulated. The desire for social gain can be influenced by approaches based upon behavioural psychology. Broaching the issue of secondary gain may be beneficial in the daily clinical routine.
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Affiliation(s)
- Heiko Pohl
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.
| | | | - Andreas R Gantenbein
- RehaClinic Bad Zurzach, Bad Zurzach, Switzerland
- University of Zurich, Zurich, Switzerland
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21
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Abutarboush R, Gu M, Kawoos U, Mullah SH, Chen Y, Goodrich SY, Lashof-Sullivan M, McCarron RM, Statz JK, Bell RS, Stone JR, Ahlers ST. Exposure to Blast Overpressure Impairs Cerebral Microvascular Responses and Alters Vascular and Astrocytic Structure. J Neurotrauma 2019; 36:3138-3157. [PMID: 31210096 PMCID: PMC6818492 DOI: 10.1089/neu.2019.6423] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Exposure to blast overpressure may result in cerebrovascular impairment, including cerebral vasospasm. The mechanisms contributing to this vascular response are unclear. The aim of this study was to evaluate the relationship between blast and functional alterations of the cerebral microcirculation and to investigate potential underlying changes in vascular microstructure. Cerebrovascular responses were assessed in sham- and blast-exposed male rats at multiple time points from 2 h through 28 days after a single 130-kPa (18.9-psi) exposure. Pial microcirculation was assessed through a cranial window created in the parietal bone of anesthetized rats. Pial arteriolar reactivity was evaluated in vivo using hypercapnia, barium chloride, and serotonin. We found that exposure to blast leads to impairment of arteriolar reactivity >24 h after blast exposure, suggesting delayed injury mechanisms that are not simply attributed to direct mechanical deformation. Observed vascular impairment included a reduction in hypercapnia-induced vasodilation, increase in barium-induced constriction, and reversal of the serotonin effect from constriction to dilation. A reduction in vascular smooth muscle contractile proteins consistent with vascular wall proliferation was observed, as well as delayed reduction in nitric oxide synthase and increase in endothelin-1 B receptors, mainly in astrocytes. Collectively, the data show that exposure to blast results in delayed and prolonged alterations in cerebrovascular reactivity that are associated with changes in the microarchitecture of the vessel wall and astrocytes. These changes may contribute to long-term pathologies involving dysfunction of the neurovascular unit, including cerebral vasospasm.
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Affiliation(s)
- Rania Abutarboush
- Neurotrauma Department, Naval Medical Research Center, Silver Spring, Maryland.,The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Ming Gu
- Neurotrauma Department, Naval Medical Research Center, Silver Spring, Maryland.,The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Usmah Kawoos
- Neurotrauma Department, Naval Medical Research Center, Silver Spring, Maryland.,The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Saad H Mullah
- Neurotrauma Department, Naval Medical Research Center, Silver Spring, Maryland.,The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Ye Chen
- Neurotrauma Department, Naval Medical Research Center, Silver Spring, Maryland.,The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Samantha Y Goodrich
- Neurotrauma Department, Naval Medical Research Center, Silver Spring, Maryland.,The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Margaret Lashof-Sullivan
- Neurotrauma Department, Naval Medical Research Center, Silver Spring, Maryland.,The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Richard M McCarron
- Neurotrauma Department, Naval Medical Research Center, Silver Spring, Maryland.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jonathan K Statz
- Neurotrauma Department, Naval Medical Research Center, Silver Spring, Maryland.,The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Randy S Bell
- Neurosurgery Department, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - James R Stone
- Department of Radiology and Medical Imaging, University of Virginia Medical Center, Charlottesville, Virginia
| | - Stephen T Ahlers
- Neurotrauma Department, Naval Medical Research Center, Silver Spring, Maryland
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22
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Williams KA, Lawson RM, Perurena OH, Coppin JD. Management of Chronic Migraine and Occipital Neuralgia in Post 9/11 Combat Veterans. Mil Med 2019; 184:e207-e211. [DOI: 10.1093/milmed/usy405] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/24/2018] [Accepted: 11/29/2018] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The rate of chronic migraine (CM) has been shown to be 20% or greater in the post 9/11 combat veteran population with a history of traumatic brain injury, while the rate is much lower at 3–5% in the general population. Studies have shown that medications such as oral topiramate or intramuscular injections of onabotulinum toxin A (Botox) have been used for CM prevention, and occipital blocks have been shown to be helpful in treating occipital neuralgia and short-term relief of CM. However, there are no known studies that have specifically evaluated the use of Botox and occipital blocks for reducing headache frequency in the US veteran population. The purpose of this study was to evaluate the effectiveness of using occipital blocks and Botox as dual therapy for reducing headache frequency in post 9/11 combat veterans with CM, occipital neuralgia, and a history of TBI or neck trauma.
Materials and Methods
Following Institutional Review Board approval, a retrospective chart review was completed on post 9/11 combat veterans treated in a headache clinic located at the Central Texas Veteran Health Care System. The electronic medical record was used to retrieve the charts of post 9/11 combat veterans who (1) had a confirmed deployment-related history of TBI or neck trauma; (2) were diagnosed with CM and occipital neuralgia; and (3) were treated in the headache clinic between January 1, 2014 and December 31, 2015 with the administration of occipital blocks and Botox within the first six months. Of 282 charts that were reviewed, a total of 30 (N = 30) veterans fit the criteria. The mean number of self-reported headache days per month (28 days) for the month prior to starting treatment was compared to the number of headache days per month (28 days) 6 months after initiation of therapy.
Results
Results revealed that the mean number of headache days in the month prior to treatment was 24.1 (22.0, 25.7). The mean number of headache days in the month post-treatment (6 months after the initiation of dual therapy with occipital blocks and Botox) was 12.9 (9.7, 16.4). The mean difference in the number of headache days from pre- to post-treatment (pre-treatment minus post-treatment) was 11.2 (8.2, 14.2).
Conclusion
This study evaluated the effectiveness of using occipital blocks and Botox as dual therapy for reducing headache frequency for post 9/11 combat veterans with CM, occipital neuralgia, and a history of TBI or neck trauma. Results revealed a statistically significant reduction in the number of headache days per month after the dual therapy. There were multiple limitations to the study to include a small sample size, lack of a control group, self-reported headaches for only 1 month pre-and post-treatment, and no control for other interventions or events which may have influenced the outcome. There is a strong need for randomized, double blinded, placebo- controlled studies involving dual therapy in this population. This study, though small, may be helpful in stimulating additional studies and treatments in this veteran population.
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Affiliation(s)
- Karen A Williams
- Central Texas Veterans Health Care System, Medical Service, 1901 Veterans Memorial Drive, Temple, TX
| | - Robin M Lawson
- University of Alabama, Capstone College of Nursing, 650 University Blvd, E, Tuscaloosa, AL
| | - Osvaldo H Perurena
- Central Texas Veterans Health Care System, (Retired) 1901 Veterans Memorial Drive, Temple, TX
| | - John D Coppin
- Central Texas Veterans Health Care System, Research Service, Biostatistician,1901 Veterans Memorial Drive, Temple, TX
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23
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Klaric JS, Forbes LL, Finkel AG. Painful Craniofacial/Cervical Surface Area and Continuous Headache After Military Concussion: A Morphometric Retrospective Cohort Study. Headache 2018; 58:1457-1464. [PMID: 30362523 DOI: 10.1111/head.13416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 07/03/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE In this retrospective study of active duty service members (ADSMs), possible relationships were examined between extent of headache pain depicted on head/neck diagrams and headache phenomenology. BACKGROUND The signature injury of US military operations in Iraq and Afghanistan is mild traumatic brain injury (mTBI). Blast injury, especially from improvised explosive devices, was the most common cause during the height of the wars; the most persistent symptom remains posttraumatic headache (PTH). Neurologic patients were asked to draw pain diagrams/maps, a method of pain assessment in several clinical settings. METHODS Thirty-four ADSMs attributing PTH to both blast and non-blast sources underwent clinical evaluations; diagnoses and headache characteristics were obtained. They completed 58 drawings depicting craniofacial/cervical headache pain on non-standardized templates. Drawings were of 29 continuous and 29 non-continuous headaches (CHA and NCHA, respectively). Surface area was calculated using a grid and expressed as a percentage. RESULTS The sample was male (100%), primarily white (83%), with an average age of 30.3 years. Evidence for statistical independence of observations is provided (intra-class correlation = 0.004). Percent surface area was larger for CHA (median [mdn] = 35.2, interquartile range [IQR] = 9.0, 78.3) than NCHA (mdn = 9.1, IQR = 5.4, 34.1, P = .029). In those with blast injury, CHA percent surface areas (mdn = 45.9, IQR = 27.0, 100) were larger than NCHA (mdn = 11.6, IQR = 5.8, 28.9; P = .0012), a relationship not observed in patients with PTH from non-blasts (CHA: mdn = 26.8, IQR = 8.5, 52.0; NCHA: mdn = 9.1, IQR = 5.0, 47.6, P = .050). This pattern is observed after pooling at the median (blast, P < .012; non-blast: P = .264). CONCLUSION Painful craniofacial/cervical surface area, as shown on patient drawings, is related to PTH phenomenology (continuous versus non-continuous headache). This relationship is stronger after blast injury.
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Affiliation(s)
- John S Klaric
- Womack Army Medical Center (WAMC), Ft. Bragg, NC, USA
| | | | - Alan G Finkel
- Womack Army Medical Center (WAMC), Ft. Bragg, NC, USA.,Defense and Veterans Brain Injury Center, Silver Spring, MD, USA.,Carolina Headache Institute, Chapel Hill, NC, USA
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24
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Factors Associated with Sport-Related Post-concussion Headache and Opportunities for Treatment. Curr Pain Headache Rep 2018; 22:75. [DOI: 10.1007/s11916-018-0724-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Finkel AG, Klaric JS, Yerry JA, Choi YS. Staying in service with posttraumatic headache. Neurology 2017; 89:1186-1194. [DOI: 10.1212/wnl.0000000000004358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/22/2017] [Indexed: 01/03/2023] Open
Abstract
Objective:To predict the probability of a military outcome (medical discharge/retirement) in patients with mild traumatic brain injury from a clinical analysis of predetermined patient and headache characteristics.Methods:This retrospective cohort study sampled all new patients referred for headache evaluation at the Brain Injury Clinic of the Womack Army Medical Center, Ft. Bragg, NC (August 2008–January 2010). Headache characteristics were extracted and analyzed. Multivariable binary logistic regressions were conducted to predict probability of medical discharge/retirement.Results:Ninety-five soldiers (age 31.3 ± 7.4 years, male 93.7%) reported 166 headaches. The most common injury cited was a blast (53.7%). Patients with a continuous headache have almost 4 times the odds of a medically related discharge/retirement compared to patients without such a headache (continuous headache regression coefficient estimate: p < 0.042, odds ratio 3.98, 95% Wald confidence interval 1.05–15.07). Results suggest that, compared to service members who did not have a continuous headache, patients with headache histories with severe holocephalic pain who medicate to keep functioning had the highest probability of medical discharge/retirement.Conclusions:Certain headache characteristics may be predictive of military outcomes after mild traumatic brain injury, and we propose a profile that may be useful in that prediction. These data could be useful in future attempts to assess and treat patients with posttraumatic headache and to advise longer-term planning for return to duty or discharge.
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Abstract
Hemicrania continua (HC) is an indomethacin-responsive primary headache disorder which is currently classified under the heading of trigeminal autonomic cephalalgias (TACs). It is a highly misdiagnosed and underreported primary headache. The pooled mean delay of diagnosis of HC is 8.0 ± 7.2 years. It is not rare. We noted more than 1000 cases in the literature. It represents 1.7% of total headache patients attending headache or neurology clinic. Just like other TACs, it is characterized by strictly unilateral pain in the trigeminal distribution, cranial autonomic features in the same area and agitation during exacerbations/attacks. It is different from other TACs in one aspect. While all other TACs are episodic, HC patients have continuous headaches with superimposed severe exacerbations. The central feature of HC is continuous background headache. However, the patients may be worried only for superimposed exacerbations. Focusing only on exacerbations and ignoring continuous background headache are the most important factors for the misdiagnosis of HC. A large number of patients may have migrainous features during exacerbation phase. Up to 70% patients may fulfill the diagnostic criteria for migraine during exacerbations. Besides migraine, its exacerbations can mimic a large number of other primary and secondary headaches. The other specific feature of HC is a remarkable response to indomethacin. However, a large number of patients develop side effects because of the long-term use of indomethacin. A few other medications may also be effective in a subset of patients with HC. Various surgical interventions have been suggested for patients who are intolerant to indomethacin. Several aspects of HC are still not defined. There is a great heterogeneity in types of patients or articles on the HC in the literature. Diagnostic criteria have been modified several times over the years. The current diagnostic criteria are too restrictive in some aspects. We suggest a more accommodating type of criteria for the appendix of International Classification of Headache Disorder (ICHD).
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Affiliation(s)
- Sanjay Prakash
- Department of Neurology, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth University, Vadodara, Gujarat, India
| | - Payal Patel
- Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH, USA
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Hong CK, Joo JY, Shim YS, Sim SY, Kwon MA, Kim YB, Chung J. The course of headache in patients with moderate-to-severe headache due to mild traumatic brain injury: a retrospective cross-sectional study. J Headache Pain 2017; 18:48. [PMID: 28429236 PMCID: PMC5398969 DOI: 10.1186/s10194-017-0755-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 04/12/2017] [Indexed: 01/03/2023] Open
Abstract
Background Little is known about the long-term course of headache in patients with moderate-to-severe headache due to traumatic brain injury (TBI). We evaluated the course of headache in patients with moderate-to-severe headache due to mild TBI. Methods Since September 2009, patients with TBI prospectively rated their headache using a numeric rating scale (NRS). From the database containing 935 patients with TBI between September 2009 and December 2013, 259 patients were included according to following criteria: (1) newly onset moderate-to-severe headache (NRS ≥ 4) due to head trauma; (2) age ≥ 15 years; (3) Glasgow Coma Scale ≥ 13; (4) transient loss of consciousness ≤ 30 min; and (5) radiographic evaluation, such as computed tomography or magnetic resonance image. We evaluated initial and follow-up NRS scores to determine the significance of NRS changes and identified risk factors for moderate-to-severe headache at 36-month follow-up. Results At 36-month follow-up, 225 patients (86.9%) reported improved headache (NRS ≤ 3) while 34 (13.1%) reported no improvement. The NRS scores were significantly decreased within a month (P < 0.001). The follow-up NRS scores at 12-, 24-, and 36-months were lower than those at one month (P < 0.001). Multiple logistic regression analysis showed that post-traumatic seizure (odds ratio, 2.162; 95% CI, 1.095–6.542; P = 0.041) and traumatic intracranial hemorrhage (odds ratio, 2.854; 95% CI, 1.241–10.372; P = 0.024) were independent risk factors for moderate-to-severe headache at 36-month follow-up. Conclusions The course of headache in patients with mild TBI continuously improved until 36-month follow-up. However, 13.1% of patients still suffered from moderate-to-severe headache at 36-month follow-up, for whom post-traumatic seizure and traumatic intracranial hemorrhage might be risk factors.
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Affiliation(s)
- Chang-Ki Hong
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea.,Severance Institute for Vascular and Metabolic Research, Yonsei University, Seoul, Republic of Korea
| | - Jin-Yang Joo
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea
| | - Yu Shik Shim
- Department of Neurosurgery, Inha University School of Medicine and Hospital, Incheon, Republic of Korea
| | - Sook Young Sim
- Department of Neurosurgery, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
| | - Min A Kwon
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea
| | - Yong Bae Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea
| | - Joonho Chung
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea. .,Severance Institute for Vascular and Metabolic Research, Yonsei University, Seoul, Republic of Korea. .,Department of Neurological Surgery, Rush University Medical Center, 1725 W. Harrison St., Professional Building Suite 855, Chicago, IL, 60612, USA.
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28
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Finkel AG, Ivins BJ, Yerry JA, Klaric JS, Scher A, Sammy Choi Y. Which Matters More? A Retrospective Cohort Study of Headache Characteristics and Diagnosis Type in Soldiers with mTBI/Concussion. Headache 2017; 57:719-728. [DOI: 10.1111/head.13056] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Alan G. Finkel
- Womack Army Medical Center (WAMC); Ft. Bragg NC USA
- Defense and Veterans Brain Injury Center; Silver Spring MD USA
- Carolina Headache Institute; Durham NC USA
- University of North Carolina School of Medicine; Chapel Hill NC USA
| | - Brian J. Ivins
- Defense and Veterans Brain Injury Center; Silver Spring MD USA
| | | | | | - Ann Scher
- Uniform Services University; Bethesda MD USA
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