HeadWise HeadWise: Volume 1, Issue 3 - Page 20

invisible wounds By Katherine Osos Ready, MD, later suggested the pain was perpetuated or worsened by posttraumatic stress disorder (PTSD), an anxiety condition some people develop after living through a harrowing event. “With PTSD, you’re putting undue stress upon yourself,” Nunnery says. “Because you’re ever-vigilant, you’re always on edge, looking over your shoulder, thinking [something bad is] still coming. That makes the headaches even worse.” The military risk factor Stand Down Exploring the relationship between migraine and PTSD in the military. T he first time he was under fire, a shock wave from a distant explosion knocked him back in his seat. The second time, a mortar attack drove shrapnel into the left side of his head. The third time—the event that eventually forced Sgt. Christopher Nunnery home and required 19 reconstructive surgeries—a rocket-propelled grenade attack demolished the right side of his face. After more than 10 years of service in the army—and after surviving three brutal encounters in Iraq—Nunnery had to medically retire in 2006. Today, at age 39, he lives in Harker Heights, Texas, and is still seeking relief from the intense chronic migraines that began after the second attack. Although the head pain was initially attributed to his physical injuries, Nunnery’s physician, Michael | Volume 1, Issue 3 • 2011 Due to advances in body armor and other protective equipment, soldiers today endure injuries and survive blasts that would have been fatal in previous wars, says Alan Finkel, MD, contractor for the Henry Jackson Foundation and Defense and Veterans Brain Injury Center at Fort Bragg, N.C., and co-founder of the Carolina Headache Institute. But while they survive, one in five soldiers returns home from combat with haunting visions of death and destruction that lead to nightma res, flashbacks, difficulty sleeping and emotional numbness—the signature markers of PTSD. Military migraineurs are particularly vulnerable to this anxiety disorder. Of 2,200 returning soldiers, 19 percent suffered from migraine, and twice as many migraineurs had PTSD, according to researchers at Madigan Army Medical Center at Fort Lewis in Tacoma, Wash. A bi-directional relationship It’s unclear whether headaches trigger anxiety in soldiers or vice versa, says Dr. Ready, director of the Headache Clinic at Scott and White Healthcare in Temple, Texas, located just 30 miles from Fort Hood. But what is clear is that the two conditions make each other worse. 20 HEAD WISE