Studying the Link Between Seizures and Migraine in Soldiers with TBI

Although advances in protective equipment and armor have helped increase survival rates among men and women in the military, more soldiers returning from Iraq and Afghanistan are experiencing the long-term consequences of traumatic brain injury (TBI), according to researchers from the University of Utah. K.C. Brennan, MD, assistant professor in the Department of Neurology, and Edward Dudek, PhD, professor and chair of the Department of Physiology, are teaming up with the Department of Defense to investigate the long-term effects of TBI on those returning from Iraq and Afghanistan.

“The long-term consequences of TBI can leave our returning servicemen and women completely incapacitated,” said Dr. Brennan, the study’s lead author. “Post-traumatic epilepsy (PTE) and post-traumatic headache (PTH) are two of these consequences, and they are probably related: both likely result from increased excitation in the brain."

In PTE, the excitation of the brain results in a seizure, whereas in PTH, it can cause cortical spreading depression (CSD), an event that can trigger a severe migraine-like headache, according to Dr. Dudek.

“The fact that many service personnel suffer from both of these conditions at the same time offers a clue that both PTE and PTH may have a common origin in TBI,” he said. “Evidence from intensive care units suggests that this is the case: patients after TBI suffer from both seizures and CSD, and these two events seem to interact with one another.”

The study, which is funded by the Department of Defense, will provide $725,000 over a 3-year period to investigate seizures and CSD together to better understand how TBI can trigger PTE and PTH. The investigators hope that understanding this will allow them to develop better treatments for service personnel and veterans, as well as others with TBI.

The study will attempt to define the time period when patients are most at risk in order to determine when seizures and CSD occur, and how they interact with each other so that treatment can be delivered when needed. The researchers predict that they will occur together in clusters, during the first few days following injury.

“We will also look into what generates seizures and CSD after brain injury,” said Dr. Dudek. “To answer this we will use a variety of imaging and electrical recording tools to dissect the underlying mechanisms within the brain. Only by understanding these mechanisms will we be able to anticipate what damage is likely to occur, and thus prevent it. Our suspicion is that the same mechanisms that lead to repair in the brain also leave the brain in a more excitable state, and we plan to test this possibility.”

The ultimate goal, according to Brennan, is to determine whether the changes that lead to PTE and PTH after traumatic brain injury can be prevented. “Using the information gained in the first two portions of the study, we will try to prevent these changes with memantine, a medication we identified as a headache preventive, which also prevents CSD and shows promise in enhancing recovery from brain injury,” he noted. “Our hope is that medications like memantine could be used after TBI, to improve recovery, and to prevent PTE and PTH.”