Pain Continuity, Not Headache Type, Affects Return to Duty

FORT BRAGG, NC — Headaches and how to manage the pain are difficult issues for soldiers who suffered mild traumatic brain injury during the wars in Afghanistan and Iraq and their care providers.

An article in the journal Headache described the diagnostic types and characteristics of the condition and how persistent post-traumatic headache interferes with returns to activity or duty1.

With the most-commonly cited headache diagnosis after concussion being migraine, researchers from Womack Army Medical Center at Fort Bragg and colleagues hypothesize that headache diagnosis type is not sufficient to predict relationships with occupational outcomes after concussion.

For the retrospective observational study, researchers focused on all new patients referred for headache evaluation at the Brain Injury Center at Womack Army Medical Center over a one-year period. Clinical data reviewed included demographics, causes of injury, headache characteristics and headache diagnosis type.

After reviewing records for retention or severance from military service, study authors determined that the primary occupational outcome measure was departure from service due to medical cause as determined by a Medical Evaluation Board (MEB). The primary outcome measure was to test the strength of association between leaving service and headache characteristics or diagnosis.

Results identified 95 patients (94% male) with concussion who described 166 distinct headache types, the most common being migraine (60%) and trigeminal autonomic cephalalgia (24%). About 25% of the patients remained on active duty.

A continuous headache of any type was present in 75% of patients and, of these, 23% remained on active duty. Of the 51% of patients who had both a continuous and non-continuous headache, 17% remained on active duty.

“Therefore, we report that a continuous headache, regardless of diagnosis type was associated with negative occupational outcomes,” the researchers noted. “Regardless of headache duration, headache diagnosis type alone was not associated with soldiers’ separations from service.

The study found that persistent post-traumatic headache is most likely to present with continuous pain and that migraine is the most common primary diagnosis type.

“The presence of a continuous headache was strongly associated with negative occupational outcomes,” researchers concluded. “Primary headache diagnosis type was not. Headache characteristics, therefore, may be more important than diagnosis type when determining active duty status. Further prospective research is indicated.”

  1. 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 Feb 27. doi: 10.1111/head.13056. [Epub ahead of print] PubMed PMID: 28239838.

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