1. Post-Traumatic Headaches in Veterans: TBI or PTSD? Kavita Manchikanti, PGY-2 May 23, 2013

2. Traumatic Brain Injury “disruption of brain function as a result of an external force marked by LOC, PTA, alteration in mental state, neurologic deficits, or intracranial lesion” (VA/DoD Clinical Practice Guidelines for Management of Concussion/mTBI 2009) Mild TBIModerate TBISevere TBI Initial GCS13-159-12<9 LOC0-30 mins>30 mins, <24 hours>24 hours Alteration of consciousness A moment up to 24 hours >24 hours PTA0-1 day>1 and <7 days>7 days. Prevalence and treatment of headaches in veterans with mild traumatic brain injury. Patil VK, St Andre JR, Crisan E, Smith BM, Evans CT, Steiner ML, Pape TL. Headache. 2011 Jul-Aug;51(7):1112-21. doi: 10.1111/j.1526-4610.2011.01946.x.

3. Traumatic Brain Injury (TBI)

4. Post-Traumatic Headache (PTH)  Onset within 7 days of head trauma or regaining consciousness  Secondary headache  No defining clinical features  Chronic >3 months  Inverse relationship with TBI severity

5. Characteristics and treatment of headache after traumatic brain injury: a focused review. Lew HL, Lin PH, Fuh JL, Wang SJ, Clark DJ, Walker WC Am J Phys Med Rehabil. 2006 Jul;85(7):619-27. Review. Treatment of PTH Physical and Psychological Evaluation Peripheral mechanism Physical therapy or simple analgesics Central mechanism Migraine-like headache Acute: analgesics, NSAID, ergotamines, triptans Prophylaxis: Ca Channel blockers, anticonvulsants, antidepressants, beta blockers Tension-type-like headache Acute: Analgesics, NSAIDs Prophylaxis: antidepressants, muscle relaxants Psychological and behavioral therapies usually necessary

6. PTSD and TBI Relationships between mild traumatic brain injury sustained in combat and post-traumatic stress disorder. Ruff RL, Riechers RG, Ruff SS. F1000 Med Rep. 2010 Aug 19;2:64. doi: 10.3410/M2-64.

7. Research Plan Post Traumatic Headaches: A Description and Comparison of Headache Patterns in Traumatic Brain Injury and Post-Traumatic Stress Disorder

8. Objective Describe and compare headache patterns in veterans with TBI versus those with PTSD. Aim 1: Describe headache characteristics (onset, frequency, duration, location, severity, triggers, quality, associated symptoms, response to treatment) in groups of veterans exposed to blasts who have been diagnosed with either TBI or PTSD. Aim 2: Compare headache characteristics between groups of veterans diagnosed with TBI or PTSD to determine if a significant difference exists.

9. Design OEF/OIF Veterans with blast exposure Positive TBI Screen Neuropsych Testing TBI Profile Headache Profile PTSD Profile Mixed TBI/PTSD Neither Negative TBI Screen Mental Health Clinic PTSD Headache Profile

10. Hypothesis Traumatic Event PTSDHeadachesTBI