STUDY NOTES BRAIN INJURIES TO FORT LEWIS SOLDIERS
February 25, 2009 -- 20:41 PST
SEATTLE -- A study conducted at Fort Lewis found mild traumatic brain injury in 15 percent to 25 percent of the soldiers deployed to Iraq or Afghanistan.
Nearly 98 percent of the soldiers who experienced a concussion, head injury or blast exposure had headaches, and 40 percent of those said the headaches interfered with daily activities.
The study of 978 soldiers was conducted by a doctor at Madigan Army Medical Center, Brett Theeler. It will be presented at a meeting of the American Academy of Neurology beginning April 25 in Seattle.
The study says health care providers need to identify and properly treat headaches among soldiers.
Sen. Patty Murray has sponsored legislation to increase research and treatment of brain injuries.
THE ACHES OF WAR: SOME IRAQ AND AFGHANISTAN VETS SUFFER FREQUENT HEADACHES
By Katherine Harmon
February 24, 2009
There are currently 184,000 troops deployed in Iraq and Afghanistan, about 15 percent of whom have suffered brain injuries from concussions, physical injury, or blast exposure. A new survey of about 1,000 soldiers with these injuries suggests that the effects can be lasting: Nearly all of them suffered from headaches, according to research released this week by the American Academy of Neurology.
The study, led by Capt. Brett Theeler, chief resident of the Madigan Army Medical Center Neurology Clinic at Fort Lewis in Tacoma, Wash., found that 30 percent of the surveyed soldiers suffered headaches at least 15 days out of the month, and at least 15 percent reported that the pain was bad enough to hamper their daily activities.
The cause of these headaches is complex, and not yet well understood, says Karen Tucker, a neuropsychologist at the Durham Veterans Affairs Medical Center in North Carolina, who was not involved in the study. Civilians might experience these sorts of headaches after a car accident or a concussion. But in the line of duty, soldiers can be exposed to more frequent physical injury as well as explosions -- which range from improvised explosive devices (IEDs) to mortar fire -- that can leave them with mild traumatic brain injury.
Fred Flynn, director of Madigan's Traumatic Brain Injury (TBI) program, describes such injury as "either a loss of consciousness or a transient alteration of consciousness," which leaves people "feeling dazed, like [they've] had their bell rung." But this doesn't include soldiers who have lost consciousness for more than 30 minutes or have an injury that can be detected on an MRI or CT scan.
Most of the headaches are "not that debilitating," says Tucker, who works with veterans suffering from persistent neurological problems. She calls the majority post-traumatic headaches "more of a significant annoyance" that should taper off and disappear within a year. Theeler notes that most of the soldiers seem to be treating their headaches on their own with ibuprofen (such as Advil and Motrin) and acetaminophen (such as Tylenol).
"These findings should alert health care providers," Theeler said in a statement, "to the need to identify and properly treat headache[s] among soldiers."
Although headaches are the most common complaint following a mild brain injury, Theeler and Flynn are also looking into the other symptoms, which can be physical (nausea, light sensitivity, balance problems); cognitive (difficulty concentrating, memory problems); and behavioral (irritability, impulsiveness, anxiousness, depression and post-traumatic stress disorder).
The research was based on a survey of 978 U.S. Army soldiers in the TBI program at Fort Lewis last year. Results will be presented at the American Academy of Neurology's annual meeting that runs April 25 to May 2 in Seattle.
AAN: HEADACHES AFTER BRAIN INJURY COMMON AMONG RETURNING VETS
February 24, 2009
TACOMA, Wash. -- Soldiers who had mild head trauma while serving in Iraq or Afghanistan are returning to the U.S. with a high prevalence of headache, researchers here said.
Nearly 98% of soldiers who'd had a concussion, head injury, or blast exposure on duty reported having headaches, Brett J. Theeler, M.D., of Madigan Army Medical Center here, and colleagues reported in an abstract that will be presented at the American Academy of Neurology meeting in April.
"Headaches are highly prevalent among returning U.S. soldiers with a history of mild traumatic head injury," the researchers said. "Post-traumatic headaches tend to be migraine-like and contribute to functional impairment in this population.
Dr. Theeler said that 15% to 25% of soldiers deployed to Iraq or Afghanistan return with mild brain injury. However, the prevalence of headaches associated with such injuries had not been studied, the researchers said.
To determine the prevalence and clinical characteristics of post-traumatic headaches among returning soldiers, they conducted a cross-sectional study of a cohort of veterans who had an initial evaluation at the Traumatic Brain Injury Program at Ft. Lewis, Wash., from June 2008 to October 2008.
Each soldier had returned from Iraq or Afghanistan three months before taking the survey. Those who screened positive for a concussion, head injury, or blast exposure were given a 13-item headache questionnaire and 95% -- 978 of 1,033 -- completed the questionnaire.
There were 963 males (98%) and 15 females (2%), and average age was 27.1. Of those, 97.8% had reported having headaches in the last three months of deployment.
Survey results showed a mean headache frequency of 8.4 days per month. Mean headache severity was 5.4 out of a possible 10. Headaches typically lasted about 4.4 hours. Three of 10 of the soldiers with post-traumatic headaches experienced 15 or more headache days a month.
The researchers said that headaches started within about a week of a traumatic brain injury in 37% of the soldiers and within one to four weeks in 20%.
About 60% whose headaches started within 1 week of a concussion, head injury, or blast, reported that their headaches had three or more migraine-like features and about 40% said their headaches interfered with normal activities.
"These headaches can be a source of impaired occupational functioning," Dr. Theeler said. "These findings should alert healthcare providers . . . to the need to identify and properly treat headache among soldiers."
(The study was supported by the Comprehensive Neuroscience Program at the Uniformed Services University of the Health Sciences by a grant from the Congressionally Directed Medical Research Program. The researchers reported no conflicts of interest.)
Primary source: American Academy of Neurology
Source reference: Theeler BJ, et al "Post-traumatic headaches after mild head injury in U.S. soldiers returning from Iraq or Afghanistan" AAN 2009.