Post-Traumatic Headache in Veterans

Alan Finkel, MD, FAHS outlines the most effective ways to treat veterans with post-traumatic headache

Veterans are a patient population who is particularly susceptible to post-traumatic headache (PTH) and confusion about how to get the best care available. There is a growing body of knowledge and research, but with many more veterans than headache specialists it is common for these patients to go untreated.

Dr. Alan Finkel, Neurologist, and military PTH specialist practicing at the Carolina Headache Institute in Durham, North Carolina, recently spoke on how to diagnose post-traumatic headache in veterans and effectively treat it. Watch the full interview from the 2018 Scottsdale Headache Symposium here:

In order to effectively treat the patient, Dr. Finkel advises that healthcare providers working with veterans ask the following questions: 1) When did your headaches start, and how? 2) Did you experience headaches before you were in the service, or did they begin following an injury during deployment? 3) Can you describe your headaches in your own words; how many types of headaches do you have?

By asking these questions, the healthcare provider is working toward obtaining a comprehensive medical history of the patient. “For veterans, in particular, we have to take into account whether or not the patient has had other injuries or exposures,”says Dr. Finkel. He remarked how some veterans are from recent wars and some from others: “I have several patients who were from Desert Storm, and there were exposures to chemicals that were nerve agents. These kinds of exposures may have also caused people to have chronic headaches.”

To help the most, detailed information is vital to determining an effective treatment plan. “Approximate the diagnosis, and determine whether their head pain has the factors that resemble migraine,” Dr. Finkel says. “Post-traumatic headache may act as if it’s migraine, and it may respond to treatments for migraine. We do not have the science to tell us that’s absolutely true yet.”

Additionally, Dr. Finkel advises that healthcare providers ask the patient about their life post-service, and how headaches have affected their relationships and ability to work.

“There are pride issues that many veterans carry with them, and they can feel inadequate. Delaying treatment can really lead to many problems, including problems in relationships and self-respect,” Dr. Finkel says.

“My advice to the clinician who is working with a veteran: Be willing to spend time with them, be respectful if a patient does not want to talk about what happened to them,” Dr. Finkel says. “Make sure you address their headache the same way you would any other patient who has chronic headaches, but with an ear for stories of trauma.” making sure the connection you make is safe, secure and guided by the best care these patients deserve.”