Post-traumatic Headaches in Civilians and Military Personnel

A Comparative, Clinical Review

Brett Theeler, MD; Sylvia Lucas, MD, PhD; Ronald G. Riechers II, MD; Robert L. Ruff, MD, PhD


Headache. 2013;53(6):881-900. 

In This Article

Abstract and Introduction


Post-traumatic headache (PTH) is the most frequent symptom after traumatic brain injury (TBI). We review the epidemiology and characterization of PTH in military and civilian settings. PTH appears to be more likely to develop following mild TBI (concussion) compared with moderate or severe TBI. PTH often clinically resembles primary headache disorders, usually migraine. For migraine-like PTH, individuals who had the most severe headache pain had the highest headache frequencies. Based on studies to date in both civilian and military settings, we recommend changes to the current definition of PTH. Anxiety disorders such as post-traumatic stress disorder (PTSD) are frequently associated with TBI, especially in military populations and in combat settings. PTSD can complicate treatment of PTH as a comorbid condition of post-concussion syndrome. PTH should not be treated as an isolated condition. Comorbid conditions such as PTSD and sleep disturbances also need to be treated. Double-blind placebo-controlled trials in PTH population are necessary to see whether similar phenotypes in the primary headache disorders and PTH will respond similarly to treatment. Until blinded treatment trials are completed, we suggest that, when possible, PTH be treated as one would treat the primary headache disorder(s) that the PTH most closely resembles.


Headache is one of the most common and persistent symptoms following traumatic brain injury (TBI)[1–3] and has been particularly targeted by recent studies addressing mild TBI (mTBI, Table 1 ) in returning military personnel and athletes.[4–9] This manuscript addresses the following aspects of post-traumatic headache (PTH): (1) epidemiology of PTH; (2) features of PTH in civilian and US military populations; (3) relationships between TBI and PTH genesis; (4) interactions of comorbid conditions such as post-traumatic stress disorder (PTSD), and mood and sleep disorders with PTH; (5) our suggestions for revision of International Classification of Headache Disorders (ICHD-2) criteria for PTH.[10]