AAN: Migraine in Iraq Vets a Marker for Psychiatric Disorders

BOSTON, May 3 -- Migraine headaches among veterans of combat in Iraq indicate a more than twofold risk for depression, post-traumatic stress disorder (PTSD), and anxiety, reported military researchers.

Half of all soldiers returning from the conflict in Iraq who reported having migraine were also found to have depression, compared with 27% of those without migraine, said Major Jay C. Erickson, M.D., Ph.D., of the Madigan Army Medical Center in Tacoma, Wash.

Moreover, Dr. Erickson said in a briefing at the American Academy of Neurology meeting here, 58% of all combat vets with migraine had one or more symptoms suggestive of a psychiatric disorder.

"We believe this study is unique in two ways," he said. "It is the first to examine the co-occurrence of migraine and psychiatric conditions in a military population. In addition, we think it may be the first study in any population to establish a link between migraine and post-traumatic stress disorder."

Previous studies have shown that one quarter of all veterans treated at Veterans Affairs hospitals after returning home from the wars in Iraq and Afghanistan brought mental health problems back with them. When psychosocial and behavioral problems were thrown into the mix, nearly a third of all veterans of Afghanistan and Iraq who sought care at a VA facility had a diagnosis of a mental-health-related disorder.

In addition, more than half of the returning vets who had a mental health diagnosis were found to have two or more mental health disorders, yet only one in five veterans returning from combat duty in Iraq or Afghanistan with signs of post-traumatic stress disorder was actually screened for it, the Government Accountability Office reported in May 2006.

"In the general population, depression and anxiety are two- to-threefold more common in individuals with migraine," Dr. Erickson said. "We therefore predicted that one or more psychiatric conditions would be more common in soldiers with migraine compared to soldiers without migraine after a combat deployment."

Dr. Erickson and colleagues conducted a cross-sectional, questionnaire-based study in soldiers returning from combat operations in Iraq. A total of 3,621 soldiers at Fort Lewis, Wash., who underwent health screening within 90 days of returning from Iraq were studied. The soldiers were given a 15-item headache questionnaire, based on International Headache Society diagnostic criteria, to screen for migraines during the previous 12-month deployment, and to asses the frequency, severity, and duration of headaches during the last three months of their deployments.

The authors classified reported headaches as migraines if they were unilateral or throbbing, severe enough to disrupt normal activities or were exacerbated by physical activities, and if they were accompanied by nausea and/or photophobia. They screened for depression and anxiety using the Patient Health Questionnaire, with depression defined as a score of 5 or higher, and anxiety defined as a score of 2 or higher on the Patient Health Questionnaire Anxiety scale.

Of the 60% of soliders who completed all of the screening instruments, 96% were male, 90% were non-officer rank, and the average age was 27. The demographic characteristics are representative of army combat units, Dr. Erickson said.

They found that 19% of soldiers reported having headaches suggestive of migraines while they were deployed, 32% screened positive for depression, 22% for PTSD, and 9% screened positive for anxiety. In addition, 39% of soldiers had symptoms suggestive of at least one of the psychiatric conditions.

"When we compared the screening prevalence of each psychiatric condition between soldiers with and without migraine headaches, we found that a higher proportion of soldiers with migraine headaches had symptoms of depression, PTSD, or anxiety," Dr. Erickson said. "In general, psychiatric conditions were twice as common in soldiers with migraines compared to those without migraines.

Fifty percent of all soldiers with migraine screened positive for depression, compared with 27% of soldiers without migraine (odds ratio 2.61, P=0.001). PTSD symptoms were seen in 39% of migraines compared with 18% of soldiers without migraine (odds ratio 2.81, P=0.001), and anxiety symptoms were seen in 17% of those with migraines, compared with 7% of those without migraine (odds ratio 2.50, P=0.001). In addition, 58% of soldiers with migraine had symptoms of one or more psychiatric conditions, compared with 34% of soldiers without migraine.

"These findings indicated that soldiers with migraine are more likely to have symptoms of psychiatric symptoms after a combat tour, with depression and PTSD being the most prevalent," Dr. Erickson said.

The authors also found that soldiers with migraines who had symptoms of depression tended to have more frequent headaches, an average of 3.5 days per month, compared with 2.5 days per month compared with soldiers without depression. Similarly, soldiers with migraine and symptoms of PTSD had an average of 3.5 headache days per month, compared with 2.7 headaches day per month in soldier without signs of post-traumatic stress. There was no effect of anxiety on headache frequency, however.

Neither pain severity nor duration of migraines were significant in any of the soldiers studied, Dr. Erickson noted.

"The results indicate that soldiers with migraine headaches are more likely to have certain psychiatric conditions following a combat deployment," he said. "This knowledge will assist in the early diagnosis and treatment of soldiers with these health problems."

Another implication of the study, he said, is that the co-morbidity he and his colleagues observed suggesst similar underlying mechanisms, identification of which could lead to better treatment and prevention of the conditions in soldiers deployed in combat.