The health risks that accompany war don’t always go away as soon as military service members plant their boots on home soil. Many soldiers suffer head injuries during their tour of duty, which puts them at a high risk for developing migraine and chronic headaches.
Although this pain can cause serious complications if left untreated, some soldiers don’t seek help for their headaches. Years after returning from the battlefield, many veterans still feel the effects of combat through post-traumatic headache and traumatic brain injury (TBI).
Fortunately, resources are available, and military health professionals are actively researching ways to effectively treat combat-related head injuries so they can improve quality of life for veterans.
TBI in Soldiers
In the first quarter of 2011, more than 9,800 members of the Armed Forces experienced some form of TBI—and about 30,000 military service members suffer a TBI each year—according to the Armed Forces Health Surveillance Center.
“Most of these injuries are mild TBI, also known as a concussion,” says Lt. Col. Jay Erickson, MD, PhD, neurologist and assistant chief of neurology at Madigan Army Medical Center in Tacoma, Wash. “Less than 1 percent of TBIs in soldiers are severe TBI.”
But when it comes to head injuries, mild doesn’t necessarily mean minor. Dr. Erickson has conducted extensive research on headaches in the military. In a study published in the journal Headache in 2010, Erickson and his colleagues found that nearly 20 percent of soldiers returning home from Afghanistan or Iraq experienced a concussion as a result of combat. In addition, they found that more than one in three of these soldiers had post-traumatic headaches, which are more intense than the “normal” headaches civilians typically experience. More than half (58 percent) of those post-traumatic headaches were classified as migraine.
“Compared with headaches not directly attributable to head trauma, post-traumatic headaches are associated with a higher frequency of headache attacks and an increased prevalence of chronic daily headache,” wrote Dr. Erickson and his colleagues.
There are a number of ways soldiers can develop post-traumatic headaches—both combat-related and otherwise.
“Head injuries in service members can be related to combat—shrapnel and fragments, bullets, explosions, etc.—but also to falls and motor vehicle accidents,” says Ann I. Scher, PhD, associate professor of epidemiology at Uniformed Services University in Bethesda, Md. “There is a lot of interest right now in blast-related injuries, including repeated mild injuries.”
Scher is currently involved in a study at Fort Carson and Fort Bragg in which she and her colleagues are measuring headache symptoms in soldiers returning from deployment in Iraq or Afghanistan. The research team found that most soldiers—regardless of whether they experienced a TBI—reported headaches after returning home. However, migraine was more common in soldiers who had a TBI.
“We are doing a follow-up study in which we will be studying their headache symptoms more carefully and will also be following them for one year to see how they do,” she says.
Diagnosis and Treatment
The symptoms of TBI vary depending on a number of factors—namely the severity of the injury and how much time has lapsed since the injury, Dr. Erickson says. Headaches are among the most common symptoms of TBI. Other symptoms include dizziness, difficulty with memory and concentration, sleep problems and mood changes.
It’s important that soldiers—particularly veterans—learn to recognize these symptoms, Dr. Erickson says. Although it might be easy to downplay the seriousness of headaches or delay treatment, doing so opens the door to potential complications, such as chronic headaches, insomnia, depression and anxiety.
For deployed soldiers who suffer a potentially concussive event, the military conducts a medical evaluation as soon as possible. Soldiers also have TBI screenings when they return from deployment and when they enter the Veterans Affairs system, according to Dr. Erickson. If a soldier meets the criteria for TBI, one major goal of the treatment regimen is to avoid a repeat event.
“A rare but potentially fatal complication is second-impact syndrome, which occurs when someone has another concussion before they have fully recovered from the initial concussion,” Dr. Erickson says.
For a successsful recovery, military service members need a treatment regimen that includes medications for headaches, nausea, sleep difficulties and mood changes; plenty of rest; and a gradual return to regular activities. Migraine medications may also be necessary for those who develop chronic headaches, Dr. Erickson says.
Regardless of whether the headaches are chronic or less frequent, the important thing is to get them treated as soon as possible. With all of the resources available, soldiers and veterans don’t have to suffer their pain alone.
Help for Heroes
Whether you are looking to learn more about TBI, find a health care provider or connect with other soldiers, these online resources can help:
• Defense and Veterans Brain Injury Center: www.dvbic.org
• NHF’s War Veterans Resource Initiative: www.headaches.org/warveterans
• The Bob Woodruff Foundation: www.ReMIND.org
