Headache, Migraine Risk with TBI

Military service members who experienced mild to severe traumatic brain injuries were significantly more likely to later suffer from headaches and migraines, according to the results of a study published in Medical Surveillance Monthly Report.

“Given the potential for headache and migraine to lead to duty limitations following a TBI, especially over the long term, patients, military leaders, and medical providers can use this knowledge to anticipate not only the health needs and return to duty of injured service members, but also the implications for their careers and the overall strength of the military as well,” wrote Vincent P. Beswick-Escanlar, MD, MPH, of Uniformed Services University of the Health Sciences and Royal Canadian Medical Service, and colleagues. “Medical service planners can use post-injury follow-up projections to ensure that resources are made available to meet anticipated needs.”

According to the study, traumatic brain injury is common in the United States. This is especially true among U.S. Armed Forces where between 2000 and 2012 about 200,000 military members sustained a traumatic brain injury. Headache and migraine that occur as a result of brain injury can have long-term effects. With this study, Beswick-Escanlar and colleagues wanted to determine if increasing severity of brain injury was associated with a greater risk for headache or migraine.

The researchers compared the incidence of diagnosed headache or migraine in 111,018 service members with a first-time mild or moderate/severe traumatic brain injury and compared outcomes with matched samples without brain injury. Of these injuries, 91.9% were considered to be mild and 8.1% were classified as moderate to severe. Among those members who had moderate/severe injury, 27.3% reported a headache or migraine within 1-year of their injury compared with 15.2% of those diagnosed with a mild injury, and 3.3% of the matched control group.

“As expected, the majority of initial presentations for headache or migraine following a TBI occurred earlier in the year of follow-up rather than later,” the researchers wrote. “Half of those who would develop headache or migraine did so within the first 12 weeks, and two-thirds by week 19. This observation suggests that patients and providers should continue to anticipate presentation for these symptoms as late as 3 months after a TBI.”

During 1 year of follow-up the annual incidence of headache or migraine increased from 1,084 to 1,769 per 10,000 person years among members with a mild injury. The incidence of headache or migraine doubled from 2,283 to 4,819 per 10,000 person years among members diagnosed with moderate/severe injuries.

After an adjusted analysis, the researchers calculated that those diagnosed with a mild traumatic brain injury were four times more likely to have headache or migraine and those with a moderate/severe injury were almost nine times more likely than were people without brain injury.

“Service members who sustain a TBI and their leaders may find it helpful to understand the risk of headache and migraine following TBI and the expected time frame for presentation, and to gauge the potential for symptoms, their need for medical attention, and their likelihood to be able to perform unrestricted duty,” the researchers wrote.

Reference: Beswick-Escanlar VP, et al. Increasing severity of traumatic brain injury is associated with an increased risk of subsequent headache or migraine: a retrospective cohort study of U.S. active duty service members, 2006-2015.  MSMR.  2016;23(7):2-8.