In 2001, Teasdale and Engberg published an article in the Journal of Neurology, Neurosurgery and Psychiatry, entitled Suicide after Traumatic Brain Injury: A Population Study. The researchers reviewed data from Danish hospital admissions covering the years 1979-93 and found that patients who had sustained a TBI had an increased risk of suicide. The authors in that study concluded, “The increased risk of suicide among patients who had an MTBI may result from concomitant risk factors such as psychiatric conditions and psychosocial disadvantage. The greater risk among the more serious cases implicates additionally physical, physiological, and social consequences of the injuries as directly contributing to…suicide.”

In a recent research article, Lauren B. Fisher, et al. evaluated data from a brain injury-focused database, the BI Model Systems National Database, to further evaluate whether or not suicide rates are higher in TBI patients. Using patient health questionnaires detailing self-reported suicide attempts over a period of twenty years, the authors concluded that those who suffer a TBI are indeed at “greater risk for depression and suicidal behavior.” The outcome of the study indicates the need for “routine screening and mental health treatment in this population.”

It is well known that headache is one of the most common debilitating chronic pain conditions in patients who sustain a mild traumatic brain injury (mTBI). No conventional pharmacological treatment has been shown to be effective in treating headaches related to traumatic brain injury (TBI). I recently read an interesting abstract published in Pain Physician; 19(2)(E 34754)- entitled rTMS in Alleviating Mild TBI Related Headaches – A Case Series.

In this study, the authors designed a perspective evaluation in patients with established diagnoses of mild traumatic brain injury related headaches who were treated with neuronavigational guided rTMS. The study was conducted at the Veterans Administration San Diego Health Care System, where over 400 patients with mTBI are evaluated annually.

The study included six men (average age of 50) with mTBI-HA. Constant headaches were rated at 4 on a 0-10 numerical rating pain scale (NRPS) and all patients were on stable headache medication regiments. Each of the patients received 4 sessions of rTMS over a 2 month period.

Following the treatment, the patients were again evaluated. The average post rTMS headache intensity was reduced by 53.05%. The average headache exacerbation frequency per week was reduced by approximately 79% with 2 patients reporting complete cessation of severe headache episodes.

The authors concluded that rTMS offered a “non-evasive” treatment option for MTBI-HA.

(Pain Physician. 2016 Feb;19(2):E347-54. rTMS in Alleviating Mild TBI Related Headaches – A Case Series)

There has been much research with regard to the long term effects of mild traumatic brain injury (MTBI) and post traumatic stress disorder (PTSD) as independent conditions.  However, there has been very little research studying the combined effect of MTBI and PTSD. 

This month’s Journal of Neurotrauma contains an article by Walter High, M.D. and his colleagues at the University of Kentucky, Department of Physical Medicine and Rehabilitation, Neurosurgery and Psychology.  Dr. High and his colleagues conducted a multi site study looking at the collective as well as the individual effects of MTBI and PTSD on an individual’s psychological, and cognitive functioning abilities.

The participants in the studies underwent a series of neuropsychological testing to measure their cognitive functioning.  The participants were classified as MTBI only, PTSD only, or both.  The results of the studies suggested that veterans suffering from both PTSD and MTBI have a poor cognitive and psychological outcome than those diagnosed with only one of the two conditions.  A link to the University of Kentucky press release can be found here.