Download - Post-Traumatic Headaches in Veterans: TBI or PTSD? Kavita Manchikanti, PGY-2 May 23, 2013
Traumatic Brain Injury
“disruption of brain function as a result of an external force marked by LOC, PTA, alteration in mental state, neurologic deficits, or intracranial lesion” (VA/DoD Clinical Practice Guidelines for Management of Concussion/mTBI 2009)Mild TBI Moderate TBI Severe
TBI
Initial GCS 13-15 9-12 <9
LOC 0-30 mins >30 mins, <24 hours
>24 hours
Alteration of consciousness
A moment up to 24 hours
>24 hours >24 hours
PTA 0-1 day >1 and <7 days >7 days
.Prevalence and treatment of headaches in veterans with mild traumatic brain injury.Patil VK, St Andre JR, Crisan E, Smith BM, Evans CT, Steiner ML, Pape TL.Headache. 2011 Jul-Aug;51(7):1112-21. doi: 10.1111/j.1526-4610.2011.01946.x.
Post-Traumatic Headache (PTH)
Onset within 7 days of head trauma or regaining consciousness
Secondary headache
No defining clinical features
Chronic >3 months
Inverse relationship with TBI severity
Characteristics and treatment of headache after traumatic brain injury: a focused review.Lew HL, Lin PH, Fuh JL, Wang SJ, Clark DJ, Walker WCAm J Phys Med Rehabil. 2006 Jul;85(7):619-27. Review.
Treatment of PTHPhysical and Psychological
Evaluation
Peripheral mechanism
Physical therapy or simple analgesics
Central mechanism
Migraine-like headache
Acute: analgesics, NSAID,
ergotamines, triptans
Prophylaxis: Ca Channel blockers, anticonvulsants, antidepressants,
beta blockers
Tension-type-like headache
Acute: Analgesics, NSAIDs
Prophylaxis: antidepressants, muscle relaxants
Psychological and behavioral
therapies usually necessary
PTSD and TBI
Relationships between mild traumatic brain injury sustained in combat and post-traumatic stress disorder.Ruff RL, Riechers RG, Ruff SS.F1000 Med Rep. 2010 Aug 19;2:64. doi: 10.3410/M2-64.
Research PlanPost Traumatic Headaches: A Description and
Comparison of Headache Patterns in Traumatic Brain Injury and Post-Traumatic Stress Disorder
Objective
Describe and compare headache patterns in veterans with TBI versus those with PTSD.
Aim 1: Describe headache characteristics (onset, frequency, duration, location, severity, triggers, quality, associated symptoms, response to treatment) in groups of veterans exposed to blasts who have been diagnosed with either TBI or PTSD.
Aim 2: Compare headache characteristics between groups of veterans diagnosed with TBI or PTSD to determine if a significant difference exists.
DesignOEF/OIF Veterans with blast exposure
Positive TBI ScreenNeuropsych Testing
TBI ProfileHeadache Profile
PTSD Profile
Mixed TBI/PTSD
Neither
Negative TBI ScreenMental Health Clinic
PTSDHeadache Profile