The Veterans Health Administration (VHA) established the Headache Centers of Excellence (HCoE) Program as a response to VA Public Law 115-141 (Military Construction, Veterans Affairs, and Related Agencies Appropriation Act, 2018; Division J of the Consolidated Appropriations Act, 2018).

The VHA recognized that over 350,000 Veterans sustained traumatic brain injury (TBI) during the Global War on Terror. It also recognized that chronic migraine/post-traumatic headache is the signature symptom of TBI. Posttraumatic headaches occur in up to 92% of military personnel who have sustained mild TBI and is associated with chronic daily headaches.

The prevalence of chronic daily headaches in returning soldiers after a deployment-related concussion is 20% higher than that seen in the general U.S. population.

The mission for the HCoE clinical care team is to provide quality headache care to Veterans. Treatments options take a holistic approach, and are dependent on the individual needs and preferences of the Veteran.

This can include both medication and non-medication options such as cognitive behavioral therapy, physical modalities, neuromodulation devices, physical therapy, exercise, sleep, diet and nutrition changes.

The HCoE is also heavily involved in the VA Whole Health Initiative, which focuses on utilizing complementary and integrative health and encouraging patient self-management.

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The HCoE Program's scope includes:

• Clinical care: Providing specialized care for Veterans with history of traumatic brain injury, post-traumatic headache, or refractory headaches.
  • Interdisciplinary care teams with access to a headache medicine-trained practitioner.
  • Telehealth options to support the veteran where they are.
• Research: Conducting studies on various types of headaches, including migraine, posttraumatic, and headache related to TBI.
• Education: Training physicians in headache treatments and educating the public.

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Please note that the VA Headache Centers of Excellence (HCoE) are specialized resources and are not intended for all Veterans experiencing headache or migraine. Your VA healthcare provider (HCP) will determine if a referral to a HCoE is appropriate based on your individual medical needs and the complexity of your condition. All headache and migraine management begins with your primary VA HCP.