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Introduction: Mild traumatic brain injury (TBI) affects a significant number of military personnel, primarily because of physical impact, vehicle incidents, and blast exposure. Post-traumatic headache (PTH) is the most common symptom reported following mild TBI and can persist for several years. However, the current International Classification of Headache Disorders lacks phenotypic characterization for this specific headache disorder. It is important to appropriately classify the headache sub-phenotypes as it may enable more targeted management approaches. This systematic review seeks to identify the most common sub-phenotype of headaches in military personnel with PTH attributed to mild TBI., Methods: We conducted a systematic search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines, focusing on the military population. PubMed, Web of Science, Cochrane, and Clinicaltrials.gov databases were searched. Abstracts and full texts were independently reviewed by two authors using predefined inclusion and exclusion criteria. Data extraction was performed using a standardized form. The risk of bias was assessed using the Newcastle-Ottawa Scale., Results: Eight papers related to the military population were included in this review. Migraine was the most commonly reported headache sub-phenotype, with a prevalence ranging from 33 to 92%. Additionally, one military study identified tension-type headaches as the most prevalent headache phenotype. Although not the primary phenotype, one military cohort reported that approximately one-third of their cohort experienced trigeminal autonomic cephalalgias, which were associated with exposure to blast injuries and prior concussions., Conclusion: This systematic review demonstrated that PTH in the military population frequently exhibit migraine-like features. Tension-type headache and trigeminal autonomic cephalalgias also occur, although less commonly reported. Sub-phenotyping PTH may be important for initiating effective treatment since different phenotypes may respond differently to medications. The study populations analyzed in this systematic review display heterogeneity, underscoring the necessity for additional research features, more stringent criteria and comprehensive recording of baseline characteristics. Characterizing headaches following injury is crucial for an accurate diagnosis to enable effective management and rehabilitation planning for our armed forces., (© The Association of Military Surgeons of the United States 2024.)

Purpose of Review: To evaluate the available studies on structural magnetic resonance imaging (MRI) of post-traumatic headache (PTH)., Recent Findings: A systematic search of PubMed and Embase databases (from inception to February 1, 2024) identified nine relevant structural MRI studies. These studies included adult participants diagnosed with acute or persistent PTH in adherence with any edition of the International Classification of Headache Disorders. Eight studies focused on PTH attributed to mild traumatic brain injury (TBI), while one examined PTH after whiplash injury. The comparison groups consisted of healthy individuals, people with mild TBI (without PTH), and/or individuals with migraine. The eligible studies assessed brain morphometry (n = 7), both cortical morphometry and diffusion tensor imaging (n = 1), or used structural brain images for machine learning (n = 1). The main findings indicated alterations in brain regions involved in affective pain processing and cognitive functions. However, the results were largely incongruent, likely due to small sample sizes and methodologic issues. Structural MRI has shown alterations in the brains of people with PTH, particularly in regions responsible for affective pain processing, cognitive control, and visual processing. These findings align well with the clinical features commonly observed in PTH. Nevertheless, most findings were inconsistent across studies, highlighting the need for methodologic standardization and investigations with larger sample sizes., Competing Interests: Compliance with Ethical Standards. R.H.C. reports personal fees from Teva, outside of the submitted work. H.M.A. reports personal fees from Pfizer, outside of the submitted work. H.A. reports personal fees from Lundbeck and Teva, outside of the submitted work. Other authors declare no competing interests. Conflict of Interest: The authors declare no competing interests. Human and Animal Rights: All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines)., (© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Chronic post-traumatic headache (CPTH) after a mild traumatic brain injury (mTBI) has been reported in up to 60% of patients and can be extremely debilitating. While pharmacological treatments are typically used for CPTH, they frequently cause side effects and have limited effectiveness, leading individuals with CPTH to be unsatisfied with current treatment options and to seek nonpharmacological options. Acupuncture has been identified as a potential treatment option; however, the evidence in this population remains limited. The overall goal of this study was to examine the effect of a once weekly (e.g., low dose) versus twice weekly (e.g., high dose) of acupuncture treatment on CPTH in individuals with mTBI. Thirty-eight individuals were randomized to receive either 5 or 10 acupuncture treatments using a standard protocol over 5 weeks. The protocol consisted of 14 points using traditional acupuncture and 4 points using electroacupuncture. Headache outcomes, safety, treatment adherence, sleep quality, and quality of life (QOL) were assessed. The results showed that while there were no differences between dose groups for any of the outcomes assessed, acupuncture significantly reduced the number of headache days and headache pain intensity in individuals with CPTH. There were no significant changes in acute medication use or sleep quality. While there were some QOL improvements identified, these results should be interpreted with caution. Overall, acupuncture was shown to be safe and well-tolerated in people with CPTH after mTBI, and five acupuncture treatments using a standardized protocol shows promise in providing headache relief for this population.