Soldiers in Iraq Have Twice As Many Migraines

U.S. combat soldiers in Iraq are more than twice as likely to suffer migraine headaches as the general American population.

That news was reported by a military doctor at the 48th Annual Scientific Meeting of the American Headache Society in Los Angeles.

While about one in seven Americans suffers migraines or "probable migraines," more than one in three soldiers did so during the last three months of their one-year tour of combat duty, according to the doctor’s study. Just one in 20 of them had been diagnosed before being deployed.

"We're the first to study migraine in deployed soldiers," says Captain Brett Theeler, MD, a neurology resident at Madigan Army Medical Center in Fort Lewis, Wash., who presented the data.

He decided to do the study after noticing soldiers coming into the medical center at Fort Lewis who were complaining of headaches. "We had a hypothesis it would be more common ([among soldiers seeing combat],” he says.

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Migraine Rate Surprising

But he didn't expect the high rate of migraine prevalence. "The end results were surprising."

That's partly because, while 95 percent of the soldiers surveyed were men, migraine in the general population is four times more common among women, Theeler says.

Theeler and his co-researchers surveyed 2,697 soldiers from Fort Lewis, asking them to complete a questionnaire about symptoms during the last three months of their tour of duty in Iraq.

In all, 19 percent reported headaches that meet the criteria for migraine, while 18 percent reported symptoms considered "probable migraine," and 11 percent had headaches of the nonmigraine type.

Just 125 of the soldiers, or 5 percent, had been diagnosed with migraines before leaving for war.

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Headaches Affect Performance

The soldiers with definite migraines reported headaches an average of three days a month and had 470 sick call visits for them, Theeler says. So, the headaches interfered with their duties.

"And only 2 percent used triptans, the most effective medication," Theeler notes. "The remaining 97 percent used over-the-counter medications, such as acetaminophen, ibuprofen, or aspirin."

While the reason for the high rate of migraine among the soldiers isn't entirely known, it likely is due to the stress, trauma, and sleep deprivation faced by soldiers, Theeler says.

The study will probably come as a surprise even to headache specialists.

"It's a population I didn't think of," says George Sarka, MD, MPH, a physician in Laguna Hills, Calif., who sees headache patients and was attending the meeting. But, he adds, "It makes sense," with the stress of combat likely serving as a migraine trigger.

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Looking for Solutions

"The military should take heed of this," say Sarka, an assistant clinical professor of medicine at the David Geffen School of Medicine at UCLA.

Theeler agrees. "We have started to educate troop commanders," so they can be more aware of the possibility, he says.

Another strategy is to set up screening programs to identify migraine sufferers before soldiers ship out, Theeler explains.

Theeler has also begun research on posttraumatic stress disorder and migraine.

And he is following the original pool of soldiers surveyed. "Our data suggests the soldiers continue to have migraine after they get home. And they may be more severe."

Those findings are preliminary, however, Theeler says.

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By Kathleen Doheny, reviewed by Louise Chang, MD

SOURCES: Capt. Brett Theeler, MD, neurology resident, Madigan Army Medical Center, Fort Lewis, Wash. George Sarka, MD, MPH, assistant clinical professor of medicine, David Geffen School of Medicine at UCLA. 48th Annual Scientific Meeting of the American Headache Society, Los Angeles, June 22-25, 2006.