For military servicemen and women“ in theater”( in the war zone), prevention and early treatment are key to avoiding chronic headache pain and staying on tour.

WAR ZONE WOES

There’ s no doubt that a war zone can trigger new headaches and worsen existing pain. According to research published in the June 2008 edition of Headache, 19 percent of troops surveyed during the last three months of a one-year combat tour in Iraq screened positive for migraine. Another 17 percent had probable migraine and 11 percent had non-migraine headache. Of those, only 5 percent had been diagnosed with migraine prior to deployment.

On the front lines where triggers are extreme, the threshold that puts one at risk for migraine“ can get pushed lower and lower to where things that would never have triggered a headache back on Main Street are now triggering migraines,” says Anne Calhoun, MD, CAPT / MC / USNR-Ret, partner and co-founder of the Carolina Headache Institute in Chapel Hill, N. C.

Dr. Calhoun says three of the most common factors

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that can transform episodic migraine into chronic daily headache or migraine are:

Stress: From the trauma of seeing someone injured to the emotional turmoil of being away from family, stress is a constant trigger in active duty.“ If someone wanted to provoke a migraine, I couldn’ t think of better conditions than in a war zone in Afghanistan,” says Marc Husid, MD, chief of neurology at Dwight D. Eisenhower Army Medical Center in Fort Gordon, Ga.

Insufficient sleep: Sleep disrupted by stress, noise, mortar attacks and early awakening can trigger migraine and chronic headache, Dr. Calhoun says.

Medication overuse: According to Dr. Husid, an army medic’ s first response to headache pain is often to treat the service member with painkillers. But frequent use of such pain meds can lead to medication overuse headache. Dr. Calhoun stresses another often-overused drug: caffeine.“ It can convert the occasional episodic migraine stateside to chronic daily headache in theater,” she says.

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According to Dr. Husid and Dr. Calhoun, other headache triggers on the front lines include exposure to extreme temperatures, irregular meal times, explosions at close proximity, burning pits of trash or bodily waste, carrying heavy packs and body armor, and wearing helmets that put pressure on the head.

AVOIDING EVACUATION

Unfortunately, military culture tends to dissuade headache sufferers from getting the help they need.“ There are some infantry units where any complaint is a sign of weakness,” Dr. Husid says. Dr. Calhoun notes that when she was in active duty, going on sick call could put a“ black mark on your career.”

But Dr. Calhoun and Dr. Husid agree that if your head pain is worsening, it is best to find treatment to avoid turning an episodic headache into a chronic condition that may result in eventual disqualification from active service. Headaches are among the top reasons for medical evacuation of military personnel from Iraq and Afghanistan according to research from the journal Cephalalgia, published online in October 2011.

To help reduce the effect of stress, Dr. Husid suggests learning relaxation techniques prior to deployment that can be used during downtime.“ There are myriads,” Dr. Husid says,“ mindful breathing, various meditation techniques, tai chi or yoga, listening to quiet music—

any way to invoke relaxation as opposed to going out and getting a couple of drinks with the guys.”

Dr. Calhoun adds that lying on your back in bed should be reserved for sleeping, and earplugs could be used to block out noise. To preserve the sleep environment, it’ s best to avoid watching TV or reading while lying in bed during the day. Naps should also be avoided so as to keep sleep schedules consistent.

As for treating chronic headaches, Dr. Calhoun recommends soldiers eliminate caffeine intake, avoid treating mild headaches so that more intense pain will respond to treatment, and avoid overuse of acute headache medication by limiting use to no more than two days a week. Dr. Husid suggests soldiers ask about other treatments such as acute and preventive medications, Botox injections, and acupuncture, which some medics are now providing in theater.

“ There’ s always been this gung-ho, all in it sort of attitude in the military, which is an important part of readiness and a fighting spirit— but there needs to be some middle ground where people who are truly having problems can mention it, get those problems treated, and get back to duty,” says Dr. Calhoun. Ultimately, Dr. Calhoun says she hopes headache sufferers in war zones will remember that many historical military leaders had migraine, from Julius Caesar and Napoleon to Ulysses S. Grant, and“ we don’ t think of them as whiners.” HW

If you are a soldier looking for help, visit the NHF War Veterans Resource Initiative at www. headaches. org / warveterans.

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