Objective:  For OEF/OIF Veterans, evaluate whether Post-Traumatic Headache (PTH) related to a DTBI is associated with ongoing cognitive dysfunction at follow-up of 2-15 years.

Background:  Headache and cognitive dysfunction are major problems following DTBI.  This   study evaluates the relation of these using the Montreal Cognitive Assessment (MOCA) test.

Methods:  Listings of OEF/OIF Veterans deployed 2001-2016, who did (N=6000) or did not (N=16000) suffer a DTBI while deployed, were obtained from VISN 19.  From these, 94 subjects with DTBI and 72 deployed controls without history of DTBI were randomly recruited.  All subjects received the same three questionnaires (QS) in an in-person interview:  (a) TBI QS, (b) Headache QS, and (c) MOCA.  The MOCA score groups employed here were as follows: ≥26-Normal, 23-25-mildly impaired, and ≤22 moderate or worse impairment.  Headache (HA) frequency per month categories included:  ≤9-Infrequent HA (IFHA), 10-14-Frequent HA (FHA), and ≥15-Chronic Daily HA (CDH) which included chronic migraine (CM) and chronic tension-type HA (CTTH).  The Fishers Exact Test was used for comparisons

Results:  There were 94 DTBI subjects (27 IFHA, 12 FHA, 50 CM, 5 CTTH).  There were 73 controls (63 IFHA, 3 FHA, 3 CM, and 3 CTTH).  For DTBI and for controls separately, and for all DTBI vs all controls, comparisons of IFHA to FHA+CM+CTTH and of CM to IFHA were non-significant.   However, for the DTBI group, there was a trend towards increased incidence of mildly impaired MOCA score for DTBI subjects with ≥10 HA/month.  Comparing DTBI subjects to controls for CM vs IFHA, the trend towards increased mildly impaired MOCA scores for the CM group was marginally significant (p=.09).

Conclusions:  For Veterans of OEF/OIF who suffered a DTBI, PTH at a frequency ≥10/month is associated with a non-significant increase in mildly impaired cognition.  This difference  becomes marginally significant for the CM subgroup of DTBI.