Abstract: BACKGROUND: Patients with chronic mild traumatic brain injury (TBI) may experience cognitive and behavioral symptoms resembling attention-deficit/hyperactivity disorder (ADHD). Central nervous system (CNS) stimulants, used for ADHD, are not recommended for TBI but are prescribed off-label. We examined patterns and trends of prevalent stimulant use among veterans with TBI. METHODS: Of the 966,953 US veterans with TBI (2001-2023), 11,710 were prevalent users of CNS stimulants, defined as prescription fills during six months before first TBI diagnosis in the Veterans Affairs (VA) healthcare system. Patients were categorized into 2001-2014 (major active combat operatoins in Iraq and Afghanistan wars), 2015-2019 (post-combat), and 2020-2023 (COVID-19 pandemic). Prevalence (95% CI) of stimulant use per 10,000 Veterans with TBI and yearly temporal trends were estimated. Estimates during 2015-2019 and 2020-2023 were compared with 2001-2014 using absolute standardized differences (ASD; ≥10% suggesting clinically significant difference). RESULTS: Prevalent CNS stimulant use (95% CI) during 2001-2014, 2015-2019, and 2020-2023 were 83 (81-85), 150 (145-155; ASD=6%) and 194 (188-200; ASD=10%) per 10,000 Veterans, respectively. Respective rates in subgroups with opioid use disorder were 174 (165-182), 351 (333-369; ASD=11%), and 457 (434-480; ASD=16%), and attention-deficit/hyperactivity disorder were 2054 (1934-2174), 1764 (1681-1847; ASD=7%), and 1950 (1871-2029; ASD=3%). CONCLUSIONS: Prevalent CNS stimulant use among Veterans with TBI is low, despite higher temporal trends, including in high-risk subgroups. Future studies need to examine patterns and trends of incident CNS stimulant use, as well as their safety and effectiveness.