Medical experts traditionally believed that after banging your head in contact sports or a car accident, the concussive effects (headache, memory problems, dizziness) would quickly subside with some rest.
But a recent University of Oklahoma study suggests that combat-related symptoms like traumatic brain injury can persist for years without any notable improvement.
The research effort was made public last month at the American Headache Society, which studied over 500 veterans from the Iraq and Afghanistan war who screened positive for traumatic brain injury during service.
A second tier of screening for that group of 500 veterans measured the persistence and intensity of typical head injury symptoms like headaches, dizziness, impaired coordination, depression, and memory problems. This set of symptoms is collectively referred to as post-concussion syndrome.
The research data was organized according to when veterans had experienced a traumatic brain injury: within the past four years, or five to eight years prior to the screening.
The findings were troubling: none of the major post-concussion symptoms appeared to diminish over that eight-year period.
Almost 50% of veterans who had traumatic brain injury within the previous four years reported that they were still having mild-to-moderate headaches. Nearly as many, about 46 percent, said they were experiencing severe headaches.
Those numbers were almost the same for veterans who had experienced traumatic brain injuries five to eight years before, with about 45 percent reporting mild headaches and 51 percent saying they had severe headaches.
The same pattern occurred in the data for five other symptoms of post-concussion syndrome: dizziness, balance, coordination, decision making and depression. The majority of veterans in the study screened positive for all of those symptoms except depression.
“What this says is we’re not seeing recovery in veterans with these head injuries,” said Dr. James R. Couch, a professor of neurology at the University of Oklahoma medical school and the lead author. “In fact, there is a tendency that things are getting just a little worse.”
Dr. Couch said the closed-head injuries could be particularly insidious because the veterans look normal but are experiencing pain or cognitive problems that can completely disrupt their lives.
He said that the symptoms worsened more for veterans who had had more than one traumatic brain injury, suggesting a cumulative impact of head injuries. Previous research has also pointed in that direction.
Most of the 500 veterans had received their brain injuries from explosions. But Dr. Couch said the data did not seem to vary significantly with veterans who had brain injuries from other sources, like vehicle accidents.
The persistence of a range of symptoms underscores the complexity of treating traumatic brain injuries, he said, since some are psychiatric and others physical, with different medications and therapies prescribed for each. Veterans with post-concussion syndrome might also need services to find employment or salvage marriages, he noted.
Workplace Head Injuries
“We have to recognize that people who may have head injuries may look the same, but they often are not going to act the same,” Dr. Couch said. “You’ve got to stabilize the patient’s interaction with family and try to create the best milieu for the patient to be able to return to employment, stay with the family and return to self-respect.”
Dr. Couch said that the researchers considered the possibility that some people may report persistent symptoms so that they can continue receiving disability compensation.
He called that hypothetical phenomenon “compensation neurosis,” and said its existence has been debated since at least the 1880s when a German researcher found that the number of people who reported being injured in railway accidents skyrocketed after the government started paying compensation for such injuries.
But Dr. Couch said that there is also ample evidence that people generally do not report physical ailments based on whether compensation is involved.
One of the shortcomings of the study, which was partly financed by the Department of Veterans Affairs, is that it was retrospective and did not include follow-up with the veterans, Dr. Couch said. Consequently, events after a deployment, including problems with alcohol or drug abuse, or new injuries, were not considered.
Future research should focus on following a group of veterans with post-concussion syndrome over many years, not only to determine which symptoms persist but also which therapies are most effective.
That research should also look at whether veterans with head injuries tend to develop chronic traumatic encephalopathy, a serious brain disease that was once mainly associated with contact sports but has recently been discovered in young combat veterans.
“Early recognition, early treatment, is a big issue here,” he said. “If we treat these people early, we get a much better result.”
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