EPIDEMIOLOGY OF HEADACHE DISORDERS IN A MILITARY COHORT WITH AND WITHOUT TBI

Migraine or headache is a common problem in the active duty population in the recently deployed population, and is a cardinal symptom of traumatic brain injury (TBI). While there is increasing appreciation of the clinical burden of chronic post-traumatic headache (PTH) in the military population with traumatic brain injury, there are significant research gaps related to the epidemiology of PTH including lack of understanding of natural history, whether there are predisposing factors that predict the development or prognosis of headache post trauma, and, most basically, the features that distinguish PTH from other forms of chronic headache. Although diagnostic criteria for posttraumatic headache (PTH) are included in the International Classification of Headache Disorders (ICHD-IIR), these criteria are somewhat arbitrary and were not empirically defined. This lack of precision about the PTH phenotype limits the rigor of observational and interventional studies of PTH and is a primary research gap. Lack of understanding about predisposing risk factors for the development of PTH is also an important research gap. It will benefit our soldiers if we can identify those who are at greatest risk of developing chronic headache post-trauma and who might therefore benefit from early and aggressive treatment with headache prophylactic agents.The proposed observational study will address the following research questions:1) Epidemiology: What is the incidence, prognosis, and natural history of headache disorders in a deployed military population with or without exposure to TBI?2) Phenotype: Which constellation of symptoms, if any, distinguishes PTH from ¿regular¿ chronic headache and from TBI occurring without headache?3) Relationship to Injury: To what extent is chronic PTH related to injury severity or modality?4) Risk Factors: Which factors predict PTH incidence or prognosis, including but not limited to post-traumatic stress disorder (PTSD), co-existing non-headache chronic pain, pre-existing migraine, family history of pain disorders, or replicated pain genes for other chronic pain disorders?