Posttraumatic headache in combat soldiers and civilians: what factors influence the expression of tension-type versus migraine headache?

Traumatic brain injury (TBI) is highly prevalent in the United States and a common cause of posttraumatic headache (PTH) and disability. The criteria that define PTH include timelines and features that are not based on clearly established physiologic data and may result in the underrecognition and incorrect treatment of these headaches. A clear understanding of the classification of PTH becomes even more elusive when one takes into account combat-related head injuries, which are also highly prevalent and frequently lead to headaches with features that are different from those suffered by civilians with PTH. The fact that tension-type headache phenotypes are uncommon in military personnel with PTH suggests that there are features unique to the combat environment, which may predispose to the development of migraine. Further insight may also be obtained from soldiers with PTH with regard to the true pathophysiology and timelines of headache in the context of TBI.