{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T16:55:24Z","timestamp":1787849724993,"version":"build-2784847793"},"reference-count":54,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,1,3]],"date-time":"2020-01-03T00:00:00Z","timestamp":1578009600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe the clinical presentation and early clinical course of a sample of deployed U.S. military service members following concussion, underscoring the impact of pre\u2010existing migraine and other co\u2010occurring conditions. It is important to obtain a comprehensive clinical history to identify evidence of underlying migraine and other health conditions which may contribute to an individual\u2019s presenting symptoms influencing early management and outcomes following concussion. Early outcome measures assessed include headache treatment response and fitness for return to duty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute concussion is reported to result in an array of somatic, cognitive, and behavioral symptoms. It is well established that these symptoms are not specific for concussion and may result from exacerbation of pre\u2010existing or underlying medical conditions and factors. Although most symptoms attributable to concussion resolve within days to weeks, there is evidence that persistent symptoms beyond that specific recovery time may be attributable to factors other than concussion. Military populations are at risk for a number of recognized co\u2010morbid and co\u2010occurring conditions, as well as special situational and psychosocial factors which may influence symptoms and clinical course following concussion. In addition, combat\u2010related concussion frequently occurs in the setting of a blast or military vehicle accidents thus causing concurrent injuries where musculoskeletal injuries may contribute to the clinical presentation. The resultant acute stress reaction, secondary to the traumatic experience associated with concussion, may also cause or aggravate underlying psychological co\u2010morbidities that may influence presenting symptoms. Prior studies identified co\u2010morbidities associated with chronic post\u2010concussive syndrome, which we find are also present during the early phase following deployment\u2010related concussion, thereby influencing presentation and impacting recovery. This retrospective chart review was intended to demonstrate the presence and potential impact of co\u2010morbid and co\u2010occurring conditions contributing to symptoms following concussion, especially migraine due to its high prevalence among post\u2010traumatic headaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective chart review was performed by the treating neurologist of 40 service members following concussion in the deployed environment. Clinical symptoms and co\u2010morbid and co\u2010occurring conditions including evidence of pre\u2010existing migraine identified during comprehensive neurologic evaluations were collected. Both pre\u2010deployment\/pre\u2010traumatic and post\u2010traumatic headache features supporting migraine and early instituted headache management and treatment response are described. Rates of return to duty in this sample were also tabulated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Headaches were the most frequently reported acute symptom following concussion in this deployed service member population (38\/40 patients [98%]), followed by insomnia, tinnitus, impaired concentration, nausea, dizziness, anxiety, impaired balance, depression, and hearing loss. Co\u2010occurring acute injuries, acute stress reaction, and recent onset medication overuse were the most frequent co\u2010occurring conditions identified by the treating neurologist as potentially contributing to the service member\u2019s presentation. Chronic co\u2010morbidities identified included chronic headache, anxiety\/depression, insomnia, and post\u2010traumatic stress disorder. Service members with 3 or more identified co\u2010morbidities or co\u2010occurring conditions were more likely to require evacuation from theater. Pre\u2010deployment headaches were reported by 25\/40 [63%] service members, with 5\/40 [12.5%] reporting known prior personal history of migraine. Of those reporting pre\u2010deployment headaches, 21\/25 [84%] described migraine features and\/or triggers, though most [(15\/25) 60%] reported as infrequent. Daily post\u2010traumatic headaches were frequent (26\/38 [68%]) and associated with typical migraine features and\/or triggers. Of those treated with triptans (16\/40 patient [42%]), most (12\/16 patient [75%]) showed positive treatment response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Concussion in the deployed settings does not occur in isolation, with co\u2010morbid and co\u2010occurring conditions being common. Presence of multiple co\u2010morbidities appears to influence clinical course and overall recovery. Post\u2010traumatic headaches are often phenotypically fully consistent with migraine, and appear related to pre\u2010existing migraine if supported by detailed pre\u2010deployment headache history suggesting same. Careful and comprehensive history taking and evaluation is invaluable in identifying associated conditions including migraine, potentially helping clinicians with more accurate symptom attribution, diagnoses, and improved clinical management following acute concussion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.13709","type":"journal-article","created":{"date-parts":[[2020,1,3]],"date-time":"2020-01-03T07:15:22Z","timestamp":1578035722000},"page":"526-541","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Impact of Pre\u2010Existing Migraine and Other Co\u2010Morbid or Co\u2010Occurring Conditions on Presentation and Clinical Course Following Deployment\u2010Related Concussion"],"prefix":"10.1111","volume":"60","author":[{"given":"Beverly R.","family":"Scott","sequence":"first","affiliation":[{"name":"Traumatic Brain Injury Program Madigan Army Medical Center Joint Base Lewis\u2010McChord WA 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