Painful Craniofacial/Cervical Surface Area and Continuous Headache After Military Concussion: A Morphometric Retrospective Cohort Study

Abstract

Objective In this retrospective study of active duty service members (ADSMs), possible relationships were examined between extent of headache pain depicted on head/neck diagrams and headache phenomenology. Background The signature injury of US military operations in Iraq and Afghanistan is mild traumatic brain injury (mTBI). Blast injury, especially from improvised explosive devices, was the most common cause during the height of the wars; the most persistent symptom remains posttraumatic headache (PTH). Neurologic patients were asked to draw pain diagrams/maps, a method of pain assessment in several clinical settings. Methods Thirty‐four ADSMs attributing PTH to both blast and non‐blast sources underwent clinical evaluations; diagnoses and headache characteristics were obtained. They completed 58 drawings depicting craniofacial/cervical headache pain on non‐standardized templates. Drawings were of 29 continuous and 29 non‐continuous headaches (CHA and NCHA, respectively). Surface area was calculated using a grid and expressed as a percentage. Results The sample was male (100%), primarily white (83%), with an average age of 30.3 years. Evidence for statistical independence of observations is provided (intra‐class correlation = 0.004). Percent surface area was larger for CHA (median [mdn] = 35.2, interquartile range [IQR] = 9.0, 78.3) than NCHA (mdn = 9.1, IQR = 5.4, 34.1, P = .029). In those with blast injury, CHA percent surface areas (mdn = 45.9, IQR = 27.0, 100) were larger than NCHA (mdn = 11.6, IQR = 5.8, 28.9; P = .0012), a relationship not observed in patients with PTH from non‐blasts (CHA: mdn = 26.8, IQR = 8.5, 52.0; NCHA: mdn = 9.1, IQR = 5.0, 47.6, P = .050). This pattern is observed after pooling at the median (blast, P < .012; non‐blast: P = .264). Conclusion Painful craniofacial/cervical surface area, as shown on patient drawings, is related to PTH phenomenology (continuous versus non‐continuous headache). This relationship is stronger after blast injury.

Persistent posttraumatic headaches and functioning in veterans: Injury type can matter

“…11 Moreover, blast injuries are linked to greater headache prevalence and greater headache severity. 23,24 Military personnel have a uniquely higher risk of blast exposure or a combination of being exposed to a blast and having a blunt head injury in the process; however, the consequences of this unique exposure to the onset and maintenance of PTHs are not well understood.…”

“…Roughly half of the sample of U.S. Army personnel experienced at least one blast exposure and those with subsequent continuous headaches were more likely to be medically discharged 11 . Moreover, blast injuries are linked to greater headache prevalence and greater headache severity 23,24 . Military personnel have a uniquely higher risk of blast exposure or a combination of being exposed to a blast and having a blunt head injury in the process; however, the consequences of this unique exposure to the onset and maintenance of PTHs are not well understood.…”