News from the AAN meeting: Headaches in Veterans returning from Iraq and Afghanistan

I treat a lot of Veterans at the VA, and I have been struck by the remarkable number of them who are returning from Iraq and Afghanistan with headaches. In most cases these are headaches that they never had before deployment. In the patients I commonly see, the cause seems to be exposure to a blast. The blast rarely involves being hit in the head with an object and it is unusual for the patient to have lost consciousness. Usually the source of the blast is an IED, an improvised explosive device, though it can be a bomb shot from a military weapon or some other type of explosion. I even thought of writing up some of the individual cases because some of them have very classic migraines that one rarely sees begin later in life. For example, I commonly see 50 year old patients who never had a problem with headaches. Then they were merely exposed to blast at quite a distance (sometimes more than the length of a football field), shaken a bit, but not knocked unconcious or otherwise visibly affected by the explosion. And then they they started having headaches which are often very similar to those of established migraineurs who have had migraines starting in childhood and extending throughout their whole adult lives. This impression of mine has now been strongly supported by a presention at the AAN. Brett J Theeler, M.D., of the Madigan Army Medical Center and his co-workers studied the case histories of 1000 returning soldiers. They found that 98% of soldiers who had suffered any type of blast injury, including the mild ones that I mentioned above. developed some type of headache problem. Many were migraines. Others seemed more like chronic tension headaches. There is a lot more to be learned about the problems associated with traumatic brain injury, even the type that initially appears to be extremely mild. From my perspective, however, there is a bit of good news. I have found that most of these headaches are quite treatable. I have gotten good results with standard headache medications in most of the patients. In some cases the underlying headache problem appears to be getting milder over time allowing me to taper down the levels of medication.