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Soldiers in Iraq: Migraines Up, Management Down





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Migraine disease affects 6-8% of men and 18% of women or 12% of the U.S. population.

Theeler, Erickson, and Mercer undertook a study to determine the prevalence, impact, and treatment of Migraine attacks among U.S. Army soldiers in combat operations in Iraq. The prevalence and impact of Migraine disease in military personnel serving in a combat theater had not previously been studied. The results of this study are not encouraging and show that the Army needs to do more to address the medical needs of our soldiers.

Study methods:

A brigade of soldiers from Ft. Lewis, Washington, were screened with a validated head pain questionnaire immediately upon returning from a one-year tour of combat duty in Iraq. Results were screened for headache and Migraine symptoms during the last three months of deployment. Head pain was then classified into "definite Migraine," "probable Migraine," or "non-Migraine headache" using International Headache Society criteria.

Study results:

  • 2,725 soldiers were screened: 93% men, 7% women
  • The mean age was 27.4 years.
  • 19% (518) reported headaches that met the criteria for definite Migraine.
  • 17.5% (476) reported headaches that met the criteria for probable Migraine.
  • 11.4% (312) had non-Migraine headaches.
  • The mean number of headache days per month over a three-month period was
    • 7.2 for definite Migraine
    • 2.0 for probable Migraine
    • 1.7 for non-Migraine
  • Over the three-month period, the number of sick call visits for headaches was:
    • 473 for definite Migraine
    • 76 for probable Migraine
    • 17 for non-Migraine headaches
  • Only 3% (30) of the soldiers with definite or probable Migraine used triptans.

Study conclusions:

  • Migraine attacks are "unexpectedly common" among military personnel serving in a combat zone at 36% prevalence as opposed to the 12% prevalence in the U.S. population.
  • Migraines adversely impact the ability of soldiers to perform their duties.
  • Migraine attacks are a common cause of sick call visits.
  • Migraine attacks are sub-optimally managed in deployed military personnel.

Comments on this study:

“This is the first ever major D.O.D. implemented study of Migraine on in theater. Almost six years from the day that MAGNUM released its Defense of the Military Migraineur report to the Chairman of the Senate Arms Committee in 2000,” noted MAGNUM Executive Director Michael John Coleman. Mr. Coleman spoke with Capt. Brett Theeler, MD, in detail about this study and working together to improve the quality of life for our service men and woman. “Capt. Theeler’s concern for our solders who suffer from Migraine disease is an inspiration. We (MAGNUM) look forward to working with him, as well as our other contacts in the military, to make sure this study illuminates the need for real Migraine disease education and access to the best practices and treatments available to those serving in Iraq, and throughout the U.S. military.”

The study authors' conclusion that the soldiers' Migraine attacks were "unexpectedly common" is quite interesting and leads me to wonder why the prevalence of Migraine is so much higher among the soldiers than in the population at large. Maybe there's a large difference in the percentage of the population that has the genetic propensity for Migraine and the percentage that develop active Migraine disease. For example, we have readers and forum members who have a family history of Migraine disease, but had never experienced a Migraine until they experienced a physical trauma such as an auto accident. It's quite conceivable that sending soldiers into a combat zone could be the physical equivalent of an auto accident.

Given the environment of the combat zone, an increase in the frequency of Migraines is understandable as there would be a huge increase in potential Migraine triggers combined with limited opportunities for trigger management. Consider these increased potential triggers:

  • chemical fumes
  • aircraft cabin pressure
  • dehydration
  • poor or disrupted sleep patterns
  • poor or disrupted meal patterns
  • food triggers
  • weather triggers
  • noise triggers
  • increase in heat triggers, both from the weather and the gear the soldiers must wear and carry.

By addressing their last point about sub-optimal Migraine management, much could be done to address the adverse impact on the soldiers' ability to perform their duties and the number of sick call visits attributable to Migraine attacks.

This statistic is absolutely unthinkable: Only 3%, 30 out of the 994 soldiers identified as Migraineurs, were treated with triptans. Triptans are Migraine abortive medications that work in the brain to stop the Migrainous activity and all the associated symptoms. They do not work for all Migraineurs, but they do work for at least 80%, and for those 80%, they are considered the "gold standard" of Migraine treatment. It is appalling that we send our men and women into combat zones to risk their lives for another country and its citizens, yet we do not give them something as simple as triptans to combat their Migraine attacks.


Theeler, Brett J.; Erickson, Jay C.; Mercer, Renee. Department of Neurology, Madigan Army Medical Center; Fort Lewis, WA. "Prevalence and Impact of Migraine Among U.S. Army Soldiers Deployed to a Combat Theater." Research Poster Presentation. 48th Annual Scientific Meeting of the American Headache Society. Los Angeles. June 23, 2006.

Interview: Captain Brett J. Theeler, MD, and Michael John Coleman, Executive Director of MAGNUM, the National Migraine Association. June 26, 2006.

© Teri Robert, July 18, 2006


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