Experts from the Defense and Veterans Brain Injury Center (DVBIC) and the Department of Veterans Affairs provided an overview of a new clinical recommendation for headaches associated with concussion during a recent Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury webinar.

Headache is the most common symptom of concussion. Other symptoms include sleep disturbances, dizziness, confusion, nausea or vomiting, blurred vision, sensitivity to light or sound, memory problems, and behavior and mood changes.

Between 2000 and 2015, more than 344,000 service members experienced a traumatic brain injury. Approximately 82 percent of these injuries were classified as concussion. In a study of veterans of Operations Enduring Freedom and Iraqi Freedom, 74 percent reported post-traumatic headaches within 30 days of a concussion.

Before consulting the clinical recommendation, providers should conduct a focused headache examination and history, explained Dr. Ronald Riechers II, medical director of the polytrauma program at Louis Stokes Cleveland Department of Veterans Affairs Medical Center in Ohio. It’s important to get specifics on the headache itself, including the intensity, location and type of pain, he added.

“Is this a throbbing or pounding pain that might be more migraine or is it a tightness, a pressure in the back of the head and at the temples that may suggest more of a tension-type headache?” Riechers said.

He discussed the four most common types of posttraumatic headache following concussion — migraine, tension type, cervicogenic (caused by a neck problem) and headache related to neuropathic pain. He also explained treatment recommendations for each type of headache, including non-pharmacologic treatment options.

Riechers also identified red flags that require immediate referral to an emergency facility, such as a thunderclap headache, which develops very rapidly over a matter of seconds to minutes and reaches maximal intensity with significant functional impairment.

“A thunderclap headache can be suggestive or concerning for subarachnoid hemorrhage or other intracranial pathology,” Riechers said.

Dr. Donald W. Marion, DVBIC senior clinical consultant, presented real case studies from Operation Enduring Freedom. These studies allowed attendees to discuss the application of the clinical recommendation in reality-based scenarios, and led to more in-depth questions from the audience.

DVBIC released its clinical recommendation as part of a new product suite that also includes a clinical support tool, training guide and patient fact sheet.

DVBIC combines evidence from medical literature, health care research and expert opinion to develop its clinical recommendations, which are designed to help providers deliver evidence-based treatment and address the challenges associated with concussion.

The “Management of Headache Following Concussion/Mild TBI” presentation is now available.