(Scientific Session) Headache Management in a Traumatic Brain Injury Rehabilitation Program Targeting Military Special Operation Forces

Background and/or Objectives: VA Palo Alto is one of five Polytrauma centers across the United States honored to provide specialty rehabilitation care for brain injury patients and is one of seven Headache Centers of Excellence (HCOE). In response to a growing need for specialized long-term brain injury care, VA Palo Alto’s Polytrauma Transitional Rehabilitation Program (PTRP) launched an Intensive Evaluation and Treatment Program (IETP) for military Special Operation Forces (SOF) service members. We aim to highlight efficacy of the headache management program embedded in the brain injury rehabilitative care for SOF service members with a history of TBI.

Design: Prospective data was collected on headache symptoms, pain and self-efficacy upon admission and discharge from a three-week inpatient IETP program.

Setting: Headache Center of Excellence at the VA Palo Alto Health Care System.

Participants: 50 active-duty SOF patients with a history of TBI, hospitalized for rehabilitation care and treated for headaches.

Interventions: Patients receive multiple treatment modalities for headache pain and management: integrative health treatments (acupuncture, massage, chiropractic care), biofeedback, and neuromodulation devices such as the Alpha Stim Aid and Cefaly.

Main Outcome Measures: Primary measures included the Headache Management Self Efficacy Scale (HMSE), Pain Catastrophizing Scale (PCS), and General Self Efficacy score (GSE).

Results: Patients were active-duty military and had served for an average of 19 years including several deployments and combat exposure. 80% experienced post concussive syndrome including headache symptoms. For those who completed the admission and discharge questionnaires, the results demonstrated improvements in headache and pain management (15-point increase on the HMSE, 19-point increase in GSE, and 3.5-point improvement in PCS).

Conclusions: The HCOE program showed to be effective in providing interventions for headache management as shown in the HMSE. Additionally, as patients improved their headache management, they showed a decrease in pain and an increase in general self-efficacy. The HCOE is an integral component to brain injury rehabilitation care.