Combat concussions lead to lingering headaches

Almost all U.S. soldiers who experienced concussions from head blows or the blast of explosions in Iraq or Afghanistan still had headaches months later, according to preliminary results of an Army survey.

Ninety-eight percent of 978 soldiers reported persistent headaches, two to 24 months after their concussions, when they answered questionnaires at Fort Lewis, Wash., last year.

Concussions, referred to by the military as mild traumatic brain injuries, have emerged as one of the most common health problems for U.S. soldiers returning from the wars. Concussions often lead to post-traumatic stress disorder, or PTSD, a condition that throws people into states of panic or anxiety when their memories of trauma are triggered. The cause of the headaches isn't clear, one specialist said.

"Is it the PTSD or is it the concussion - that's what we don't know the answer to," said Stephen Silberstein, a professor of neurology at Thomas Jefferson University in Philadelphia and past president of the American Headache Society, in a telephone interview. "Headache specialists believe this is a real phenomenon. What we don't know is whether it's from the head trauma or just from having been in Iraq."

Future studies should compare the rates of headaches among soldiers who had concussions, PTSD without concussions or neither condition, Silberstein said.

He also said that only a minority of patients who have a head trauma will continue to have headaches three months later.

For 138 of the people in the Fort Lewis survey, the concussions and headaches they caused were so debilitating that the soldiers "had to limit their daily activities," said Brett Theeler, an Army neurologist at Fort Lewis who led the study, in an e-mail response to questions. Among these soldiers, "Headaches resulted in a total 221 sick call visits during the preceding 3 months," he wrote.

A study published in January 2008 in the New England Journal of Medicine found that 5 percent of infantry soldiers back from Iraq had suffered concussions. That research found that 44 percent of soldiers who had mild traumatic brain injuries developed PTSD.

In the Fort Lewis survey, soldiers averaged eight headaches a month that each lasted 4 to 5 hours. Those who also had PTSD seemed to experience the most headaches. Almost a third of the vets with PTSD reported suffering from headaches at least every other day.

Soldiers whose headaches began within one week of their concussion were more likely than others to suffer from migraines. Sixty percent of them had at least three migraine symptoms such as nausea, throbbing sensations, sensitivity to light or sound and visual hallucinations.