Headache among combat-exposed veterans and service members and its relation to mild traumatic brain injury history and other factors: a LIMBIC-CENC study
BackgroundHeadache (HA) is a common persistent complaint following mild traumatic brain injury (mTBI), but the association with remote mTBI is not well established, and risk factors are understudied.ObjectiveDetermine the relationship of mTBI history and other factors with HA prevalence and impact a...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-09-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1242871/full |
| _version_ | 1797679453301637120 |
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| author | William C. Walker William C. Walker Sarah W. Clark Kaleb Eppich Elisabeth A. Wilde Elisabeth A. Wilde Aaron M. Martin Aaron M. Martin Chelsea M. Allen Melissa M. Cortez Mary Jo Pugh Mary Jo Pugh Samuel R. Walton Kimbra Kenney |
| author_facet | William C. Walker William C. Walker Sarah W. Clark Kaleb Eppich Elisabeth A. Wilde Elisabeth A. Wilde Aaron M. Martin Aaron M. Martin Chelsea M. Allen Melissa M. Cortez Mary Jo Pugh Mary Jo Pugh Samuel R. Walton Kimbra Kenney |
| author_sort | William C. Walker |
| collection | DOAJ |
| description | BackgroundHeadache (HA) is a common persistent complaint following mild traumatic brain injury (mTBI), but the association with remote mTBI is not well established, and risk factors are understudied.ObjectiveDetermine the relationship of mTBI history and other factors with HA prevalence and impact among combat-exposed current and former service members (SMs).DesignSecondary cross-sectional data analysis from the Long-Term Impact of Military-Relevant Brain Injury Consortium—Chronic Effects of Neurotrauma Consortium prospective longitudinal study.MethodsWe examined the association of lifetime mTBI history, demographic, military, medical and psychosocial factors with (1) HA prevalence (“lately, have you experienced headaches?”) using logistic regression and (2) HA burden via the Headache Impact Test-6 (HIT-6) using linear regression. Each lifetime mTBI was categorized by mechanism (blast-related or not) and setting (combat deployed or not). Participants with non-credible symptom reporting were excluded, leaving N = 1,685 of whom 81% had positive mTBI histories.ResultsAt a median 10 years since last mTBI, mTBI positive participants had higher HA prevalence (69% overall, 78% if 3 or more mTBIs) and greater HA burden (67% substantial/severe impact) than non-TBI controls (46% prevalence, 54% substantial/severe impact). In covariate-adjusted analysis, HA prevalence was higher with greater number of blast-related mTBIs (OR 1.81; 95% CI 1.48, 2.23), non-blast mTBIs while deployed (OR 1.42; 95% CI 1.14, 1.79), or non-blast mTBIs when not deployed (OR 1.23; 95% CI 1.02, 1.49). HA impact was only higher with blast-related mTBIs. Female identity, younger age, PTSD symptoms, and subjective sleep quality showed effects in both prevalence and impact models, with the largest mean HIT-6 elevation for PTSD symptoms. Additionally, combat deployment duration and depression symptoms were factors for HA prevalence, and Black race and Hispanic/Latino ethnicity were factors for HA impact. In sensitivity analyses, time since last mTBI and early HA onset were both non-significant.ConclusionThe prevalence of HA symptoms among formerly combat-deployed veterans and SMs is higher with more lifetime mTBIs regardless of how remote. Blast-related mTBI raises the risk the most and is uniquely associated with elevated HA burden. Other demographic and potentially modifiable risk factors were identified that may inform clinical care. |
| first_indexed | 2024-03-11T23:14:53Z |
| format | Article |
| id | doaj.art-c5a35c319ec14cc2af350cab9f5b454d |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-03-11T23:14:53Z |
| publishDate | 2023-09-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Neurology |
| spelling | doaj.art-c5a35c319ec14cc2af350cab9f5b454d2023-09-21T04:36:46ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-09-011410.3389/fneur.2023.12428711242871Headache among combat-exposed veterans and service members and its relation to mild traumatic brain injury history and other factors: a LIMBIC-CENC studyWilliam C. Walker0William C. Walker1Sarah W. Clark2Kaleb Eppich3Elisabeth A. Wilde4Elisabeth A. Wilde5Aaron M. Martin6Aaron M. Martin7Chelsea M. Allen8Melissa M. Cortez9Mary Jo Pugh10Mary Jo Pugh11Samuel R. Walton12Kimbra Kenney13Department of Physical Medicine and Rehabilitation (PM&R), School of Medicine, Virginia Commonwealth University, Richmond, VA, United StatesRichmond Veterans Affairs (VA) Medical Center, Central Virginia VA Health Care System, Richmond, VA, United StatesRichmond Veterans Affairs (VA) Medical Center, Central Virginia VA Health Care System, Richmond, VA, United StatesDivision of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United StatesGeorge E. Wahlen VA Salt Lake City Healthcare System, Salt Lake City, UT, United StatesDepartment of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City, UT, United StatesMental Health and Behavioral Science Service, James A. Haley Veterans’ Hospital, Tampa, FL, United StatesDepartment of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United StatesDivision of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United StatesDepartment of Neurology, University of Utah, Salt Lake City, UT, United StatesInformatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, Salt Lake City, UT, United States0Department of Internal Medicine, Division of Epidemiology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United StatesDepartment of Physical Medicine and Rehabilitation (PM&R), School of Medicine, Virginia Commonwealth University, Richmond, VA, United States1Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United StatesBackgroundHeadache (HA) is a common persistent complaint following mild traumatic brain injury (mTBI), but the association with remote mTBI is not well established, and risk factors are understudied.ObjectiveDetermine the relationship of mTBI history and other factors with HA prevalence and impact among combat-exposed current and former service members (SMs).DesignSecondary cross-sectional data analysis from the Long-Term Impact of Military-Relevant Brain Injury Consortium—Chronic Effects of Neurotrauma Consortium prospective longitudinal study.MethodsWe examined the association of lifetime mTBI history, demographic, military, medical and psychosocial factors with (1) HA prevalence (“lately, have you experienced headaches?”) using logistic regression and (2) HA burden via the Headache Impact Test-6 (HIT-6) using linear regression. Each lifetime mTBI was categorized by mechanism (blast-related or not) and setting (combat deployed or not). Participants with non-credible symptom reporting were excluded, leaving N = 1,685 of whom 81% had positive mTBI histories.ResultsAt a median 10 years since last mTBI, mTBI positive participants had higher HA prevalence (69% overall, 78% if 3 or more mTBIs) and greater HA burden (67% substantial/severe impact) than non-TBI controls (46% prevalence, 54% substantial/severe impact). In covariate-adjusted analysis, HA prevalence was higher with greater number of blast-related mTBIs (OR 1.81; 95% CI 1.48, 2.23), non-blast mTBIs while deployed (OR 1.42; 95% CI 1.14, 1.79), or non-blast mTBIs when not deployed (OR 1.23; 95% CI 1.02, 1.49). HA impact was only higher with blast-related mTBIs. Female identity, younger age, PTSD symptoms, and subjective sleep quality showed effects in both prevalence and impact models, with the largest mean HIT-6 elevation for PTSD symptoms. Additionally, combat deployment duration and depression symptoms were factors for HA prevalence, and Black race and Hispanic/Latino ethnicity were factors for HA impact. In sensitivity analyses, time since last mTBI and early HA onset were both non-significant.ConclusionThe prevalence of HA symptoms among formerly combat-deployed veterans and SMs is higher with more lifetime mTBIs regardless of how remote. Blast-related mTBI raises the risk the most and is uniquely associated with elevated HA burden. Other demographic and potentially modifiable risk factors were identified that may inform clinical care.https://www.frontiersin.org/articles/10.3389/fneur.2023.1242871/fulltraumatic brain injuryconcussionheadachepostconcussive headacheveteransblast injuries |
| spellingShingle | William C. Walker William C. Walker Sarah W. Clark Kaleb Eppich Elisabeth A. Wilde Elisabeth A. Wilde Aaron M. Martin Aaron M. Martin Chelsea M. Allen Melissa M. Cortez Mary Jo Pugh Mary Jo Pugh Samuel R. Walton Kimbra Kenney Headache among combat-exposed veterans and service members and its relation to mild traumatic brain injury history and other factors: a LIMBIC-CENC study Frontiers in Neurology traumatic brain injury concussion headache postconcussive headache veterans blast injuries |
| title | Headache among combat-exposed veterans and service members and its relation to mild traumatic brain injury history and other factors: a LIMBIC-CENC study |
| title_full | Headache among combat-exposed veterans and service members and its relation to mild traumatic brain injury history and other factors: a LIMBIC-CENC study |
| title_fullStr | Headache among combat-exposed veterans and service members and its relation to mild traumatic brain injury history and other factors: a LIMBIC-CENC study |
| title_full_unstemmed | Headache among combat-exposed veterans and service members and its relation to mild traumatic brain injury history and other factors: a LIMBIC-CENC study |
| title_short | Headache among combat-exposed veterans and service members and its relation to mild traumatic brain injury history and other factors: a LIMBIC-CENC study |
| title_sort | headache among combat exposed veterans and service members and its relation to mild traumatic brain injury history and other factors a limbic cenc study |
| topic | traumatic brain injury concussion headache postconcussive headache veterans blast injuries |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1242871/full |
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