AHS: Soldiers in Iraq Suffer High Migraine Rate

LOS ANGELES, June 29 - During the last three months of their tours of duty in Iraq, U.S. soldiers were prone to twice as many migraines as the general population, according to army researchers.

This increased incidence persists for months after they return home, found a study presented at the American Headache Society meeting here in a poster session.

"Migraine headaches are unexpectedly common among military personnel serving in a combat zone," said Jay C. Erickson, M.D., a staff neurologist at Madigan Army Medical Center at Fort Lewis, Wash., and colleagues. "The results also suggest that migraine headaches are suboptimally managed in deployed military personnel."

The study surveyed 2,697 soldiers from Fort Lewis who completed a validated migraine questionnaire immediately after they returned from a one-year deployment in Iraq. The participants reported headache symptoms during their last three months overseas.

These symptoms were then classified using criteria from the American Migraine Study, which are similar to the International Headache Society criteria. Participants who had definite migraine or probable migraine based on these criteria were followed up three months later for current symptoms.

Overall, 19% (524 of 2,697) had definite migraine while in Iraq while another 18% (480 of 2,697) had probable migraine for a total of 37% with episodes of either.

Comparatively, an estimated 14% of Americans in the general population suffer migraine or probable migraine headaches.

The respondents with definite migraine reported an average of 3.5 headache days per month compared to 1.8 per month for those with probable migraine and 1.0 for those with non-migraine headache. There was a similar rate of impaired duty days per soldier per month for migraine and probable migraine.

Headache severity was 6.5 on a 10-point scale for those with definite migraine and 5.6 for those with probable migraine.

Most of those with definite migraine rated their headaches as worse during deployment than before (65%). For those with probable migraine this was 44% compared to 17% with non-migraine headache.

However, nearly all acute migraines were treated with over-the-counter analgesic agents with only 3% (30/993) of soldiers with definite or probable migraine receiving triptan medication, which is considered the more effective.

Three months later, the 377 participants followed for migraine or probable migraine still reported 5.6 headache days per month with an average severity of 6.7 on a 10 point scale.

Nearly all of the total responders were male (95%); they had an average age of 27.3 years; and 5% reported having been previously diagnosed with migraine. The survey response rate was 74%.

Dr. Erickson and Brett Theeler, M.D., a neurology resident at the same center, said the higher rate of migraine in this population could be accounted for by the stress, trauma, headgear, lack of sleep, exposure to fumes and other chemicals, and changes in diet that are common for soldiers in a combat arena and are known to be triggers for migraine.

It is possible that other soldiers in similar conditions may more migraines as well, but "we don't know if we can really generalize this," Dr. Erickson noted.