Ongoing headache in military personnel are common. Alan Finkel, MD, FAAN, FAHS, explains why soldiers ignore concussion symptoms and delay treatment
Most concussion specialists see patients who have suffered head injuries in sports, car wrecks and falls. Dr. Alan Finkel, neurologist at the Carolina Headache Institute, studies what he calls “complicated patients.” These are active duty personnel whose head injuries come from military duties like jumping out of airplanes, firing heavy artillery, regular use of plastic explosives and encounters with improvised explosive devices. “The technology of body armor improved to the point that the blast injuries don’t kill people,” he explains. “Even though helmets are designed to absorb a blast, blast injuries could come in through little areas where the goggles may not have been as tight,” says Dr. Finkel. His research has shown that 35% of the 350,000 active duty soldiers who’ve had a concussion experience headaches associated with the injury; 75% of those soldiers leave the military due to their headaches.
Some of Finkel’s military patients experience persistent post-traumatic headache, which feels like a headache that never stops. A typical patient may be a special operations soldier who sustained an injury in battle 10 years ago and stayed in the military for seven years after that. “He’s now at the VA, and he’s saying he has a headache all the time,” says Dr. Finkel. “After 10 years, what are we supposed to do? Is that now who he is? Or is it something that’s still treatable going back to the original injury?”
Health issues that contribute to headache
Headache treatment in these cases also encompasses the common health issues in soldiers like sleep problems, emotional changes, post-traumatic stress disorder and other physical pains from military service. “We have to treat the stuff that is also maybe keeping the headaches going,” Dr. Finkel says. Flashbacks, for instance, often occur as nightmares, which disturb sleep, and can lead to more intense headaches, memory and cognition problems.
With the right treatment, Dr. Finkel says, improvement can be dramatic: “People’s balance problems can really improve, their visual problems can improve, even memory function can improve. And then they’re left with headache.” In many cases, he says, botulinum toxin, or Botox, injections have shown to bring relief.
The soldier effect
One issue that comes up with military patients is a tendency to gloss over injury. The military uses a concussion screening called the Military Acute Concussion Evaluation, and Dr. Finkel has heard of soldiers memorizing the questionnaire answers in order to hide their concussion symptoms, a habit called “reverse malingering.” “They were doing everything they could to make sure that they didn’t have to leave their company or their group, and that they could stay in the mission,” Dr. Finkel says. “We call it the soldier effect.”
Unfortunately, not every VA offers optimum levels of screening and therapy for veterans with head injuries. “A person goes to the military to serve their country because they feel it’s their duty, and three years later they are discharged with headaches unable to be treated.” Knowing how effective comprehensive timely interventions can be for military personnel with headache, Dr. Finkel says, “I think that we’re doing a disservice to those people who do not get access to that kind of care.”
Alan Finkel, MD, FAAN, FAHS, is a Scientific Advisory Board Member of the International Concussion Society. The International Concussion Society sponsored website Concussion.Org is the number one destination for information related to concussion prevention, diagnosis and treatment. Our mission is to serve medical professionals, athletes, administrators, coaches, patients and the public by providing a central repository of accurate and scientifically vetted concussion research. Working alongside our world-class scientific advisory board, Concussion.org aims to be the most trusted global index on one of the most common, yet least understood, forms of traumatic brain injury. If you would like to be interviewed for an influencer profile, please fill out this form.