Holtkamp Matthew D, Grimes Jamie, Ling Geoffrey
Department of Neurology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bldg 19, 6th Floor, Neurology, Bethesda, MD, 20889, USA.
Department of Neurology, Uniformed Services University of Health Sciences, Bethesda, MD, USA.
Curr Pain Headache Rep. 2016 Jun;20(6):37. doi: 10.1007/s11916-016-0572-x.
Traumatic brain injury (TBI) is defined as an alteration in brain function caused by an external force. Mild TBI or concussion is now well recognized to be a risk of military service as well as participation in athletic sports such as football. Posttraumatic headache (PTH) is the most common symptom after mTBI in US service members. PTH most commonly presents with migraine-like headache features. The following is an overview of the epidemiology, pathophysiology, clinical course, prognosis, complications, and treatment of mTBI and associated comorbidities with a focus on PTH. There is a particular emphasis on emerging evidence-based clinical practice. One important medical consequence of the recognition that mTBI is a highly prevalent among military service members is that the Department of Defense (DoD) is dedicating significant financial and intellectual resources to better understanding and developing treatments for TBI. The identification of the importance of TBI among the US military population has had the added benefit of increasing awareness of this condition among civilian populations, particularly those engaged in both professional and youth sports. The NIH and NSF are also supporting important TBI research. President Obama's Brain Initiative is also providing additional impetus for these efforts. Unfortunately, the understanding of the acute and chronic effects of mTBI on the brain remains limited. Gratefully, there is hope that through innovative research, there will be advances in elucidating the underlying pathophysiology, which will lead to clinical and prognostic indicators, ultimately resulting in new treatment options for this very complicated set of disorders.
创伤性脑损伤（TBI）被定义为由外力导致的脑功能改变。轻度TBI或脑震荡如今已被充分认识到是军事服役以及参与诸如橄榄球等体育运动的风险因素。创伤后头痛（PTH）是美国现役军人轻度TBI后最常见的症状。PTH最常表现出类似偏头痛的头痛特征。以下是对轻度TBI及其相关合并症的流行病学、病理生理学、临床病程、预后、并发症和治疗的概述，重点是PTH。特别强调新出现的循证临床实践。认识到轻度TBI在现役军人中高度普遍所带来的一个重要医学后果是，美国国防部（DoD）正在投入大量资金和智力资源，以更好地了解和开发TBI的治疗方法。确定TBI在美国军事人群中的重要性还有一个额外的好处，即提高了平民群体，特别是从事职业和青少年体育运动的人群对这种疾病的认识。美国国立卫生研究院（NIH）和美国国家科学基金会（NSF）也在支持重要的TBI研究。奥巴马总统的“大脑计划”也为这些努力提供了额外的推动力。不幸的是，对轻度TBI对大脑的急性和慢性影响的了解仍然有限。令人欣慰的是，有希望通过创新性研究，在阐明潜在病理生理学方面取得进展，这将带来临床和预后指标，最终为这一非常复杂的病症带来新的治疗选择。
