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CORRECTION article

Front. Neurol., 16 April 2025

Sec. Neurorehabilitation

Volume 16 - 2025 | https://doi.org/10.3389/fneur.2025.1577480

Corrigendum: Headache among combat-exposed veterans and service members and its relation to mild TBI history and other factors: a LIMBIC-CENC study

  • 1. Department of Physical Medicine and Rehabilitation (PM&R), School of Medicine, Virginia Commonwealth University, Richmond, VA, United States

  • 2. Richmond Veterans Affairs (VA) Medical Center, Central Virginia VA Health Care System, Richmond, VA, United States

  • 3. Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States

  • 4. George E. Wahlen VA Salt Lake City Healthcare System, Salt Lake City, UT, United States

  • 5. Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City, UT, United States

  • 6. Mental Health and Behavioral Science Service, James A. Haley Veterans' Hospital, Tampa, FL, United States

  • 7. Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States

  • 8. Department of Neurology, University of Utah, Salt Lake City, UT, United States

  • 9. Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, Salt Lake City, UT, United States

  • 10. Department of Internal Medicine, Division of Epidemiology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States

  • 11. Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States

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In the published article, there was an error in “Figure 1. Study Sample Inclusion Flow Diagram”. After publication, the authors were informed that one site's IRB retroactively deemed their data to be invalid, and therefore cannot be published (Site #10; Eisenhower Army Medical Center; located near Augusta, GA). The updated figure reflects changes excluding the removed data and updated the results data in all main Tables and supplementary Tables; Table 1. Headache (HA) prevalence (experienced HA lately) stratified by # lifetime mTBIs; Table 2. Headache (HA) impact stratified by # lifetime mTBIs; Table 3. Post-hoc comparisons of HIT-6 headache severity categories by # lifetime mTBIs; Table 4. Categorical covariates stratified by absence/presence of Headache (HA); Table 5. Continuous covariates stratified by absence/presence of Headache (HA); Table 6. Multivariable logistic regression—experience headaches lately yes/no; Table 7. Multivariable linear regression for HIT-6 total score (multiple R2 = 0.350).

Table 1

No TBI 1-2 mTBIs 3+ mTBIs Total p-valuea
HA lately < 0.001
No 173 (54%) 292 (37%) 125 (22%) 590 (35%)
Yes 148 (46%) 504 (63%) 432 (78%) 1,084 (65%)
Total 321 (100%) 796 (100%) 557 (100%) 1,674 (100%)

Headache (HA) prevalence (experienced HA lately) stratified by # lifetime mTBIs.

aPearson's Chi-squared test; p-values bolded if < 0.05.

Table 2

Characteristic All, N = 1,084 No TBI, N = 148 1-2 mTBIs, N = 504 3+ mTBIs, N = 432 p-valuea
HIT-6 total score, mean (SD) 58.6 (8.8) 56.3 (9.4) 59.1 (8.9) 58.8 (8.4) 0.005
HIT-6 impact categories, n (%) 0.012
Little/none 167 (15%) 37 (25%) 73 (14%) 57 (13%)
Some 212 (20%) 30 (20%) 100 (20%) 82 (19%)
Substantial 162 (15%) 19 (13%) 68 (13%) 75 (17%)
Severe 542 (50%) 61 (41%) 263 (52%) 218 (50%)
Headache severe pain, n (%) 0.007
Never 22 (2.0%) 9 (6.1%) 7 (1.4%) 6 (1.4%)
Rarely 226 (21%) 35 (24%) 103 (20%) 88 (20%)
Sometimes 448 (41%) 55 (37%) 198 (39%) 195 (45%)
Very often 314 (29%) 37 (25%) 163 (32%) 114 (26%)
Always 73 (6.7%) 11 (7.5%) 33 (6.5%) 29 (6.7%)

Headache (HA) impact stratified by # lifetime mTBIs.

aKruskal-Wallis rank sum test for HIT-6 total score; Pearson's Chi-squared test for HIT-6 and severe pain frequency categories; p-value bolded if < 0.05.

Table 3

Dimension Value Never Rarely Sometimes Very often Always
No TBI Residuals 3.782071 0.9440547 −1.046433 −1.098988 0.38620065
No TBI P values 0.002333 1.00 1.00 1.00 1.00
1–2 mTBIs Residuals −1.398384 −0.3259913 −1.297286 2.265382 −0.23624680
1–2 mTBIs P values 1.00 1.00 1.00 0.352338 1.00
3+ mTBIs Residuals −1.220961 −0.3282617 2.053412 −1.538916 −0.02948149
3+mTBIs P values 1.00 1.00 0.600490 1.00 1.00

Post-hoc comparisons of HIT-6 headache severity categories by # lifetime mTBIs.

p-value bolded if < 0.05.

Table 4

Overall Experienced HA lately
Characteristic N = 1,674a N Missing No, N = 590a Yes, N = 1,084a p -value b
Gender 1 < 0.001
Male 1,458 (87%) 547 (93%) 911 (84%)
Female 215 (13%) 43 (7.3%) 172 (16%)
Race 11 0.6
White 1,224 (74%) 441 (75%) 783 (73%)
Black or African American 307 (18%) 99 (17%) 208 (19%)
American Indian or Alaska Native 15 (0.9%) 4 (0.7%) 11 (1.0%)
Asian 26 (1.6%) 7 (1.2%) 19 (1.8%)
Other 91 (5.5%) 34 (5.8%) 57 (5.3%)
Ethnicity 20 0.005
Not Hispanic or Latino 1,372 (83%) 506 (86%) 866 (81%)
Hispanic or Latino 282 (17%) 79 (14%) 203 (19%)
Blast TBI 606 (36%) 0 117 (20%) 489 (45%) < 0.001
Non-blast TBI 1,192 (71%) 0 385 (65%) 807 (74%) < 0.001
Deploy TBI 889 (53%) 0 201 (34%) 688 (63%) < 0.001
Non-deploy TBI 1,087 (65%) 0 357 (61%) 730 (67%) 0.005
Early HA after TBI* 379 (28%) 0 88 (21%) 291 (31%) < 0.001
Controlled blast exposures 0 0.017
None 464 (28%) 179 (30%) 285 (26%)
Minimal (1–9) 422 (25%) 159 (27%) 263 (24%)
Light (10–29) 272 (16%) 100 (17%) 172 (16%)
Moderate (30–98) 228 (14%) 72 (12%) 156 (14%)
Heavy (99+) 288 (17%) 80 (14%) 208 (19%)
Alcohol use (AUDIT-C) 6 0.019
None 300 (18%) 91 (16%) 209 (19%)
Moderate 788 (47%) 268 (46%) 520 (48%)
Risky 580 (35%) 228 (39%) 352 (33%)
PCL-5/PTSD 8 < 0.001
No PTSD (≤ 35) 1,171 (70%) 499 (85%) 672 (62%)
Possible PTSD (36-49) 289 (17%) 60 (10%) 229 (21%)
Highly probable PTSD (≥50) 206 (12%) 28 (4.8%) 178 (16%)
PHQ-9/depression 18 < 0.001
No depression (0–4) 598 (36%) 334 (57%) 264 (25%)
Mild depression (5–9) 485 (29%) 146 (25%) 339 (32%)
Moderate depression (10–15) 384 (23%) 85 (15%) 299 (28%)
Moderate/severe depression (≥16) 189 (11%) 21 (3.6%) 168 (16%)
BMI category 11 0.093
< 20 18 (1.1%) 5 (0.9%) 13 (1.2%)
>29 875 (53%) 289 (49%) 586 (54%)
20-29 770 (46%) 292 (50%) 478 (44%)
HTN 581 (35%) 0 187 (32%) 394 (36%) 0.076
Stroke 8 (0.5%) 0 2 (0.3%) 6 (0.6%) 0.8
Neuro disorder 71 (4.2%) 0 24 (4.1%) 47 (4.3%) >0.9
Diabetes 91 (5.4%) 0 32 (5.4%) 59 (5.4%) >0.9
OSA high risk (STOP-BANG) 313 (19%) 23 82 (14%) 231 (22%) < 0.001

Categorical covariates stratified by absence/presence of Headache (HA).

an (%).

sPearson's Chi-squared test; Fisher's exact test;

p-value bolded if < 0.05.

*N = 1,353 with positive mTBI histories.

Table 5

Overall Experienced HA lately
Characteristic N = 1,674 N Missing No, N = 590 Yes, N = 1,084 p -value a
Age (years) 0 0.039
Mean (SD) 41 (10) 42 (11) 40 (9)
Median (IQR) 39 (33, 48) 0 40 (32, 51) 39 (33, 47)
Num of lifetime mTBIs < 0.001
Mean (SD) 2.15 (1.97) 1.58 (1.69) 2.45 (2.04)
Median (IQR) 2.00 (1.00, 3.00) 1.00 (0.00, 2.00) 2.00 (1.00, 3.00)
Time since last TBI (years)* 0 < 0.001
Mean (SD) 12 (9) 14 (11) 11 (8)
Median (IQR) 10 (6, 14) 11 (7, 18) 9 (5, 13)
Num of non-blast TBIs overall 0 < 0.001
Mean (SD) 1.61 (1.66) 1.33 (1.48) 1.76 (1.73)
Median (IQR) 1.00 (0.00, 2.00) 1.00 (0.00, 2.00) 1.00 (0.00, 3.00)
Num non-blast TBIs when deployed 0 < 0.001
Mean (SD) 0.35 (0.63) 0.23 (0.50) 0.42 (0.69)
Median (IQR) 0.00 (0.00, 1.00) 0.00 (0.00, 0.00) 0.00 (0.00, 1.00)
Num non-blast TBIs not deployed 0 < 0.001
Mean (SD) 1.26 (1.42) 1.11 (1.31) 1.35 (1.46)
Median (IQR) 1.00 (0.00, 2.00) 1.00 (0.00, 2.00) 1.00 (0.00, 2.00)
Num of months combat deployed 34 < 0.001
Mean (SD) 20 (13) 18 (12) 21 (13)
Median (IQR) 15 (11, 26) 14 (10, 24) 17 (12, 28)
Combat intensity (DRRI-2) 3 < 0.001
Mean (SD) 37 (15) 33 (13) 39 (15)
Median (IQR) 34 (24, 48) 30 (22, 40) 37 (26, 50)
Num of controlled blasts 0 0.001
Mean (SD) 28 (37) 23 (34) 30 (38)
Median (IQR) 7 (0, 45) 5 (0, 30) 9 (0, 50)
Depression (PHQ9) 18 < 0.001
Mean (SD) 7.7 (5.9) 5.0 (4.9) 9.2 (5.8)
Median (IQR) 7.0 (3.0, 11.0) 4.0 (1.0, 8.0) 8.0 (5.0, 13.0)
PTSD (PCL5) 8 < 0.001
Mean (SD) 25 (19) 17 (16) 30 (18)
Median (IQR) 23 (9, 39) 12 (3, 25) 28 (15, 43)
Sleep Quality (PSQI) 28 < 0.001
Mean (SD) 10.2 (4.8) 7.9 (4.5) 11.4 (4.4)
Median (IQR) 10.0 (6.0, 14.0) 8.0 (4.0, 11.0) 12.0 (8.0, 15.0)
Social support (DRRI-2) 2 < 0.001
Mean (SD) 39 (8) 40 (8) 38 (8)
Median (IQR) 40 (34, 45) 42 (36, 47) 39 (33, 44)
Self-efficacy (GSE) 3 < 0.001
Mean (SD) 32.1 (4.8) 33.3 (4.5) 31.4 (4.8)
Median (IQR) 32.0 (29.0, 36.0) 34.0 (30.0, 37.0) 31.0 (28.0, 35.0)

Continuous covariates stratified by absence/presence of Headache (HA).

aWilcoxon rank sum test; p-value bolded if < 0.05.

*Time since last mTBI only applies to participants with positive mTBI histories (N = 1,353).

Table 6

Multivariable
Characteristic OR a 95% CI b p -value c
Gender
Male
Female 3.57 2.37, 5.48 < 0.001
Num of blast TBIs (combat and noncombat) 1.80 1.47, 2.22 < 0.001
Num of combat/nonblast TBIs 1.41 1.13, 1.78 0.003
Num of noncombat/nonblast TBIs 1.23 1.02, 1.49 0.035
Num of months combat deployed 1.23 1.04, 1.45 0.014
Controlled blast exposures
None
Minimal (1–9) 1.06 0.76, 1.48 0.7
Light (10–29) 0.98 0.67, 1.44 >0.9
Moderate (30–98) 1.23 0.81, 1.88 0.3
Heavy (99+) 1.10 0.72, 1.66 0.7
OSA high risk (STOP-BANG) 1.13 0.80, 1.62 0.5
Race
White
Black or African American 0.93 0.67, 1.29 0.7
American Indian or Alaska Native 2.35 0.57, 16.1 0.3
Asian 2.63 1.06, 7.22 0.046
Other 0.53 0.30, 0.95 0.030
Ethnicity
Not Hispanic or Latino
Hispanic or Latino 1.33 0.93, 1.92 0.12
Alcohol Use (AUDIT-C)
None
Moderate 1.27 0.89, 1.81 0.2
Risky 0.87 0.60, 1.26 0.5
HTN
No
Yes 1.20 0.92, 1.57 0.2
Age 0.76 0.62, 0.93 0.009
BMI categories
20-29
< 20 1.00 0.31, 3.62 >0.9
>29 1.03 0.79, 1.33 0.8
Depression (PHQ-9 total score) 1.56 1.13, 2.15 0.007
PTSD (PCL-5 total score) 1.54 1.07, 2.23 0.021
Sleep quality disturbance (PSQI total score) 1.78 1.40, 2.28 < 0.001
Social support (DRRI-2 social total) 1.15 0.95, 1.40 0.2
Combat intensity (DRRI-2 combat total) 1.09 0.83, 1.42 0.5
Self-efficacy (GSE total) 1.08 0.87, 1.35 0.5

Multivariable logistic regression—experience headaches lately yes/no.

aOR, Odds ratio (expressed as 75th vs. 25th percentile for continuous variables).

bCI, Confidence interval.

cp-value bolded if < 0.05.

Table 7

Multivariable
Characteristic Beta a 95% CI b p -value c
Gender
Male - -
Female 3.4 2.1, 4.8 < 0.001
Num of blast TBIs (combat and noncombat) 0.57 0.02, 1.1 0.043
Num of combat/nonblast TBIs 0.38 −0.32, 1.1 0.3
Num of noncombat/nonblast TBIs −0.09 −0.75, 0.58 0.8
Num of months combat deployed −0.01 −0.59, 0.57 >0.9
Controlled blast exposures
None - -
Minimal (1–9) −0.98 −2.3, 0.33 0.14
Light (10–29) −0.32 −1.8, 1.2 0.7
Moderate (30–98) −0.71 −2.3, 0.86 0.4
Heavy (99+) −0.71 −2.2, 0.81 0.4
OSA high risk (STOP-BANG) 0.69 −0.54, 1.9 0.3
Race
White - -
Black or African American 2.3 1.1, 3.6 < 0.001
American Indian or Alaska Native 2.9 −1.5, 7.2 0.2
Asian −1.0 −4.4, 2.4 0.6
Other 2.4 0.28, 4.5 0.027
Ethnicity
Not Hispanic or Latino - -
Hispanic or Latino 2.0 0.79, 3.3 0.001
Alcohol use (AUDIT-C)
None - -
Moderate −0.52 −1.8, 0.75 0.4
Risky −2.3 −3.6, −0.91 0.001
HTN
No - -
Yes 0.53 −0.47, 1.5 0.3
Age −0.98 −1.8, −0.12 0.026
BMI categories
20–29 - -
< 20 0.56 −3.6, 4.8 0.8
>29 −0.33 −1.3, 0.67 0.5
Depression (PHQ-9 total score) 0.67 −0.39, 1.7 0.2
PTSD (PCL-5 total) 4.9 3.6, 6.2 < 0.001
Sleep quality disturbance (PSQI total score) 1.4 0.48, 2.3 0.003
Social support (DRRI-2 social total) 0.24 −0.47, 0.94 0.5
Combat intensity (DRRI-2 combat total) 0.34 −0.61, 1.3 0.5
Self-efficacy (GSE total score) −0.70 −1.5, 0.09 0.084

Multivariable linear regression for HIT-6 total score (multiple R2 = 0.350).

1Beta expressed as 75th vs. 25th percentile for continuous variables.

2CI, Confidence Interval.

3p-value bolded if < 0.05.

In the article, there were errors in the following supplementary tables as published. Supplementary Table 1. Post-hoc comparisons HIT-6 Total Sore by Number of mild TBI groups; Supplementary Table 2. Post-hoc comparisons of HIT-6 Impact categories by Number of mild TBI groups; Supplementary Table 3. Prevalence of Headache Lately; Logistic regression sensitivity analysis including only mTBI positive participants (N = 1,234); Supplementary Table 4. Headache Impact (HIT6 Total Score); Linear Regression sensitivity analysis including only mTBI positive participants who endorsed HA Lately (N = 853).

In the published article, there were errors in the Abstract, Methods and Results sections as published. They should have been written as:

Methods: Participants with non-credible symptom reporting were excluded, leaving N = 1,674 of whom 81% had positive mTBI histories.

Results: In covariate-adjusted analysis, HA prevalence was higher with greater number of blast-related mTBIs (OR 1.81; 95% CI 1.48, 2.23) non-blast mTBIs while deployed (OR 1.42; 95% CI 1.14, 1.79), or non-blast mTBIs when not deployed (OR 1.23; 95% CI 1.02, 1.49).

In the published article, there were errors in the Methods, Participants section as published. This should have been written as:

For this secondary analysis, all LIMBIC-CENC PLS participants whose enrollment (baseline) assessment data were available at time of dataset extraction were included (n = 1,832). …. We also excluded participants with evidence of noncredible symptom reporting based on failing (126) the Mild Brain Injury Atypical Symptom (mBIAS) scale, a validated self-reported measure of symptom reporting credibility in the mTBI population using the developer's recommended cut-point of 8 or higher (Cooper et al., 2011). This left a final analytic sample of 1,674 participants (see Figure 1).

Figure 1

Figure 1

Study sample inclusion flow diagram.

In the published article, there were errors in the Results section as published. This should have been written as:

In our final sample of 1,674 combat-exposed current and former SMs, 19% had an entirely negative lifetime mTBI history, 47% had sustained 1-2 mTBIs, and 34% had 3 or more. Rates of positive history across the mTBI mechanism/setting categories were 63% for Combat mTBI(s), 67% for Non-combat mTBI(s), and 37% for Blast-related mTBI(s).

In the published article, there were errors in the Results, HA prevalence and impact across mTBI history groups (0, 1–2, 3+) section as published. This should have been written as:

For example, the rate of severe HA pain sometimes, often or always was 70% for the no TBI group compared to 78% for those with 1-2 or 3+ lifetime mTBIs. (See Table 3 for HIT-6 item #1 post-hoc testing; the other post-hoc testing data are available in Supplementary Tables S1, S2).

In the published article, there were errors in the Results, Main multivariable regression analyses section as published. This should have been written as:

For TBI history, the number of lifetime mTBIs of every type was significant, including blast-related (OR = 1.80), Blunt during combat-deployment (OR = 1.41), and Blunt outside of deployment (OR = 1.23). Other significant factors included identifying as female (OR = 3.57), age (0.76), total months combat-deployed (OR = 1.23), and symptoms of depression on PHQ-9 (OR = 1.56), PTSD on PCL-5 (OR = 1.54), and disturbed sleep quality on PSQI (OR = 1.78).

For TBI history, only blast-related mTBIs were significant (Beta 0.57). Blunt-only mTBIs did not reach significance, regardless of contextual type (combat or non-combat). Other factors found significant in the HIT-6 linear regression that were also significant in the HA prevalence logistic regression were female identity (Beta 3.4), younger age (Beta −0.98), PTSD symptoms (Beta 4.9), and reduced sleep quality (Beta 1.4). Demographic characteristics that were significant in the HIT-6 score linear regression model but not the preceding HA prevalence model were Black racial identity (Beta 2.3) and Hispanic/Latino ethnic identity (Beta 2.0) as compared with White/non-Hispanic racial/ethnic identity.

In the published article, there were errors in the Discussion section as published. This should have been written as:

Discussion

The overall sample (n = 1,674), which included 19% with negative TBI histories, had a HA point prevalence (i.e., HA lately) of 65%.

The covariate-adjusted logistic regression model for HA prevalence (see Table 6) showed higher prevalence with a greater number of any subtype of mTBI (see Table 6), with the nominally highest OR for blast-related mechanism (OR 1.80; 95% CI 1.47, 2.22).

Our large sample, which included 215 females (13%), enabled us to examine their relative risk for HA, a previously understudied research question in the military population due to insufficient numbers of females in most prior HA studies. Our results show that female sex had the nominally highest OR (3.57; 2.37, 5.48) for experiencing HA lately (see Table 6), and had a strong association with higher HA impact (Beta 3.4; 2.1, 4.8; see Table 7).

In the published article, there were errors in the Discussion, Study strengths section as published. This should have been written as:

Study strengths included our large sample (n = 1,674) of individuals with military combat exposure drawn from the LIMBIC-CENC multicenter cohort with rigorously determined lifetime mTBI histories and a large breadth of data available from their comprehensive assessments.

The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.

Statements

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Summary

Keywords

traumatic brain injury, concussion, headache, postconcussive headache, veterans, blast injuries, military medicine, prediction

Citation

Walker WC, Clark SW, Eppich K, Wilde EA, Martin AM, Allen CM, Cortez MM, Pugh MJ, Walton SR and Kenney K (2025) Corrigendum: Headache among combat-exposed veterans and service members and its relation to mild TBI history and other factors: a LIMBIC-CENC study. Front. Neurol. 16:1577480. doi: 10.3389/fneur.2025.1577480

Received

15 February 2025

Accepted

28 March 2025

Published

16 April 2025

Volume

16 - 2025

Edited and reviewed by

Sergio Bagnato, Provincial Agency for Health Services (APSS) of Trento, Italy

Updates

Copyright

*Correspondence: William C. Walker

Disclaimer

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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