The impact of traumatic injuries to the brain – whether sustained in combat or on the playing fields of America's schools – is a major topic for international migraine specialists the week of June 18 as they gather in Los Angeles for the 54th Annual Scientific Sessions of the American Headache Society. This is among many timely issues concerning headache, migraine, and brain injuries on the four-day agenda here which runs through Sunday morning, June 24.
"As migraine specialists, we cannot ignore the fact that traumatic brain injury (TBI) is an increasingly common medical problem today and that those who experience severe and untreated blows to the brain may end up with serious neurological damage and long-lasting medical and psychological problems," said Elizabeth Loder, MD, MPH, president of the American Headache Society (AHS) and Chief of the Division of Headache and Pain in the Department of Neurology at the Brigham and Women's Hospital in Boston. "We owe it to our nation's military as well as to our children in contact sports to raise awareness of TBI and make this issue a national health priority."
Dr. Loder cited a 60% increase in emergency room visits by adolescents for sports-related brain injuries over the last decade, as reported by the Centers for Disease Control late last year.
"The rising incidence of these injuries, which may have serious long-term consequences for many young people, is a public health problem of epidemic proportion," she said. "High school and collegiate athletic departments are developing programs to minimize the risks but much more is needed to prevent and recognize severe concussions related to high-impact contact sports. These injuries may result in brain damage that can cause persistent severe headache, emotional problems such as depression and anxiety, sleep disturbances, memory and learning impairment, and even degenerative brain diseases later." The symposium, on June 23, will cover "School Issues with Concussion" and "Post-Concussion Headaches" and include world-renown experts on the subject.
In earlier wars, many TBIs would have been fatal
Modern warfare and high-tech explosives have ushered in a new era of traumatic brain injury among American combat soldiers. The Defense and Veterans Brain Injury Centers (DVBIC) estimates there have been more than 178,000 traumatic brain injuries sustained by soldiers in the wars of the last 10 years.
"In earlier wars, such injuries would have been fatal, but now with improvements in protective gear our soldiers are surviving, but often crippled with excruciating headache, depression, and post-traumatic stress disorder," said Alan Finkel, MD, who has written widely on the subject. "Today we have bombs that exert 'overpressure' -- waves that come off an explosion at twice the speed of sound and compress everything in their wake without breaching either a soldier's bone or tissue. But the damage they do to the brain is enormous and unprecedented."
Dr. Finkel will chair the AHS session that includes discussion of "Military Traumatic Brain Injuries: Mild, Common, and Unique," "Epidemiology of Military Headache," and "Treating Military Post-Traumatic Headache."
Some 500 of the world's most eminent migraine and headache specialists are expected to attend. This year's theme, "Planting the Seed for Future Headache Research" will spotlight other areas of current basic and clinical research such as the role of the cortex in migraine, the role of imaging in patients with headache, the latest breaking science emerging from the nation's leading scientific laboratories in migraine research, and controversial issues in the diagnosis and management of complex headache disorders.
Migraine is one of the most ancient and mysterious of diseases with many myths and folklores attached to its diagnosis and treatment. Over the last 5,000 years, migraine sufferers subjected themselves to an array of extreme and bizarre treatments to find relief, Dr. Loder, MD, noted. These have included drilling a hole in the skull to let out the "bad humours," bloodletting, sorcery, binding a clay crocodile to the head, and inserting the bones of a vulture into the nose.
Some 36 million Americans suffer from migraine, more than have asthma and diabetes combined. An additional 6 million suffer from chronic migraine, where patients experience at least 15 headache days per month along with other disabling neurological symptoms. Migraine can be extremely disabling and costly - accounting for more than $20 billion each year in the United States. Costs are attributed to direct medical expenses (e.g. doctor visits, medications) and indirect expenses (e.g. missed work, lost productivity).