Evaluate the contribution to Post-Traumatic Headache (PTH), of PTSD, Severe Depression (SD) and TBI severity.

Veterans of Afghanistan and Iraq wars with a DTBI  and matched controls (CS) were randomly recruited.  All subjects were interviewed by a trained researcher using four questionnaires (QS):  (a) TBI QS, (b) Headache (HA) QS, (c) PTSD civ QS, and (d) Beck Depression Inventory (BDI 2). TBI was graded as: Very Mild (VMTBI - dazed only), Mild TBI (MTBI - loss of consciousness [LOC] 1-30 minutes), and Moderate-severe TBI (MSTBI – LOC >30 minutes).  PTSD and BDI QS scorings were:  PTSD - PTSD civ score ≥50; Severe depression (SD) - BDI score ≥29.  CS were age, sex, race and time of deployment matched to TBIS.  The subjects were divided into two groups (a) Chronic Daily Headache (CDH – HA occurring >3 days/week) or Intermittent headache (IH - HA occurring ≤3 days/week).

  There were 39 VMTBI of which 19 (49%) had CDH with 11 (58%)  PTSD+SD, while of 20 IH subjects 5 (25%) reported PTSD+SD. There were 44 MTBI with 29 (66%) manifesting CDH with 16 (55%) reporting PTSD+SD, while of 15 IH only 4 (27%) noted PTSD+SD.  There were 9 MSTBI of  which 5 (56%) had CDH and 4 (80%) of these, as opposed to none of 4 IH, reported PTSD+SD.  Of 70 CS, 5 (7%) had CDH with none reporting PTSD+SD, while 6/65 CS with IH noted PTSD+SD. For TBIS vs CS, differences in occurrence of PTSD+SD were highly significant (p=.0013).  Differences among the three TBI severity groups were nonsignificant for occurrence of PTSD+SD.

PTSD and SD are strongly related to PT-CDH and may relate to its causality.  Severity of TBI did not affect this relationship.