“Migraine & PTSD”

Although Migraine disease affects about 12% of the general population, a shockingly disproportionate percentage of Veterans suffer moderate-to-severe head pain including ‘acute attacks’ that characterize Migraine disease. Research by the US Department of Veterans Affairs (VA) has found that as many as one in three (36%) Veterans of the war in Iraq suffer from Migraine attacks. This is even more statistically significant when we observe that a far lesser frequency is seen in the general male population: 6%. What causes Migraine disease to be nearly six times more common in Veterans? This author and fellow sufferer thinks it’s a matter of PTSD ‘tipping the scales’.

Let’s look at Migraine disease in childhood: Approximately 10% of all children experience Migraine attacks, and the prevalence is nearly equal in girls and boys. In children, Migraine symptoms frequently appear without head pain and the prevailing symptoms are abdominal, such as nausea, vomiting, belly-aches/indigestion, etc. Yet, sometime around puberty, the gender equivalence in Migraine diverges and women become three times as likely to develop acute attacks as men; 18% of adult females suffer from the condition. But here’s where military service throws us a curve-ball: Army Soldiers with Migraine contacted 3 months after returning from Iraq had a mean of 5.3 headache days per month and 36% had a Migraine Disability Assessment Scale (MIDAS) ratings of moderate to severe impairment. (Theeler & Erickson, 2008)

In a 2011 Washington Post article, Army Specialist David Hunt recounted that two years after his deployment, he was facing mandatory medical retirement from the military due to Migraine attacks. Spc. Hunt said that the experience of Migraine is: “headache times 10. It’s really hard to handle that while shooting, moving and communicating.” And the VA agrees. Migraine that appears during service or is exacerbated by it is disability compensated by the VA. Still, the trillion-dollar question remains: What makes acute attacks over three times more prevalent for deployed soldiers in their adulthood than the 10% prevalence seen in childhood?

Researchers know there is a genetic component to Migraine disease and higher numbers of sufferers in a family tree increases a person’s ‘genetic load’. However, on top of baseline genetics, both internal and external factors contribute to development of attacks. When these flare, the central nervous system erupts into a neurological cascade of events (similar to seizures) that is typically characterized by moderate to severe, one-sided head pain.

Increased risks such as chronic stress or illness, or physical injuries might combine with a broad range of common triggers such as changes in body chemistry and lack of sleep, hydration or food to create ideal conditions for an attack. Reactions to chemicals found in food (both naturally and as additives); various intense lighting or sound conditions; offending chemicals in products used for health and beauty, laundry, housecleaning, seasonal allergies and more such as extreme weather changes, can tip the scales and bring on an attack. We all know that extreme instances of many of these conditions are embedded into the military lifestyle.

Way beyond simply a ‘bad headache’, Migraine attacks are a full-body experience with additional symptoms that may start as early as 24-48 hours before the ‘head pain’ hits. Debilitating symptoms such as nausea, vomiting and/or diarrhea harken back to those signature childhood symptoms of Migraine. Lack of balance or dropping things and extreme aversion to light, sound, smells or even movement or touch are common. Mood changes may occur, such as onset of sudden and unexplained depression, irritability or even euphoria. Incredibly frustrating and invasive common symptoms are cognitive challenges like ‘brain fog’, difficulty concentrating, ‘finding words’ or understanding them.

Migraine poses extreme challenges to employment, making it the #3 cause of disability in people under the age of 50 worldwide. It is a condition recognized and protected by the Americans with Disabilities Act (ADA). And — here is where we might find some clues — another disability recognized in both civilian and Military-affiliated Migraine sufferers frequently is PTSD.

Concurrently, a 2017 National Health and Resilience in Veterans Study approximated that 40% of Veterans with combat experience met criteria for the diagnosis of Post-Traumatic Stress Disorder. Coincidentally, among these service members with a PTSD diagnosis, 40% report the comorbid occurrence of headaches. (Afari et al., 2009) It is known that people diagnosed with PTS(D) have a higher-level of inflammation throughout their bodies as a result of stress. Generalized or ‘systemic’ inflammation is also seen evident in a higher baseline in people with Migraine disease.

When a person with Migraine becomes ‘over-loaded’ due to changing environmental conditions and exacerbating triggers, the ‘scales tip’ and their entire central nervous system is pulled into the impending attack. A neurological storm-like activity in the brain called ‘cortical spreading depression’ (CSD) culminates in a relative silencing of the neuronal system while the body’s systemic inflammation increases even further.