Current treatment of persistent post-traumatic headache and evidence for a novel tDCS treatment protocol

Traumatic brain injury is a prominent injury among veterans deployed in the conflicts of Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF), with mild TBI being the most common among this population. Headache is the most common symptom following a TBI. Specifically, post-traumatic headache (PTH) is more likely to occur following mild TBI versus moderate and severe TBIs. PTH has a migraine-like phenotype and can become chronic if persists after 3 months and can be debilitating in this population. Standard treatments of persistent PTH involve acute pain medications, but recent evidence has suggested that neuromodulation techniques, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), may improve PTH symptoms and the quality of life of veterans with mTBI. tDCS applies a low direct electrical current through electrodes placed on the scalp, altering neuronal resting membrane potential and thus brain activity. It has gained attention as a noninvasive neuromodulatory approach for depression, chronic migraine, cognitive impairment involving attention, working memory and executive function, loss of inhibitory control, sleep disturbance and aphasia. Thus, tDCS is one technique that may be of great benefit to the rehabilitation of active duty military personnel with persistent PTH.