Migraine disease affects 6-8% of men and 18% of women or 12% of the U.S. population.
Theeler, Erickson, and Mercer undertook a study to determine the prevalence, impact, and treatment of Migraine attacks among U.S. Army soldiers in combat operations in Iraq. The prevalence and impact
of Migraine disease in military personnel serving in a combat theater had not previously been studied. The results of this study are not encouraging and show that the Army needs to do more to address the medical needs of our soldiers.
Study methods:
A brigade of soldiers from Ft. Lewis, Washington, were screened with a validated questionnaire immediately upon completing a one-year tour of combat duty in Iraq. Results were screened for headache and Migraine symptoms during the last three months of deployment. Head pain was then classified into "definite Migraine," "probable Migraine," or "non-Migraine headache" using International Headache Society criteria.Study results:
- 2,725 soldiers were screened: 93% men, 7% women
- 19% (518) reported headaches that met criteria for definite Migraine.
- 17.5% (476) reported headaches that met criteria for probable Migraine.
- 11.4% (312) had non-Migraine headaches.
- The mean number of headache days per month over a three-month period was
- 7.2 for definite Migraine
- 2.0 for probable Migraine
- 1.7 for non-Migraine
- Over the three-month period, the number of
sick call visits for headaches was:
- 473 for definite Migraine
- 76 for probable Migraine
- 17 for non-Migraine headaches
- Only 3% (30) of the soldiers with definite
or probable Migraine used
triptans.
Study conclusions:
- Migraine attacks are "unexpectedly common" among military personnel serving in a combat zone at 36% prevalence.
- Migraines adversely impact the ability of soldiers to perform their duties.
- Migraines are a common cause of sick call visits.
- Migraines are sub-optimally managed in deployed personnel.
Comments on this study:
Michael John Coleman, Executive Director of MAGNUM, stated:- This is the first major D.O.D. implemented study of Migraine on in-theater, almost six years from the day MAGNUM released its Defense of the Military Migraineur report to the Chairman of the Senate Arms Committee in 2000." Coleman spoke with Theeler about this study and working together to improve the quality of life for our soldiers. "Capt. Theeler’s concern for our solders who suffer from Migraine disease is inspiring. We look forward to working with him and our other contacts in the military to make sure this study illuminates the need for Migraine disease education and access to the best practices and treatments available to everyone serving in the U.S. military."
The study authors' conclusion that the soldiers' Migraine attacks were "unexpectedly common" leads me to wonder why the prevalence is so much higher among the soldiers than the population at large. Maybe there's a difference in the percentage of the population that has the genetic propensity for Migraine and the percentage that develop active Migraine disease. For example, there are people who have a family history of Migraine disease, but never experience a Migraine until they experience a physical trauma such as an auto accident. It's conceivable that sending soldiers into a combat zone could be the equivalent of an auto accident.
Given the environment of the combat zone, an increase in the frequency of Migraines is understandable as there would be a huge increase in Migraine triggers combined with limited opportunities for trigger management. Consider these potential triggers:
- chemical fumes
- aircraft cabin pressure
- dehydration
- poor or disrupted sleep
- irregular meal patterns
- some foods
- weather
- noise
By addressing their point about sub-optimal Migraine management, much could be done to address the adverse impact on the soldiers' ability to perform their duties and the number of sick call visits attributable to Migraines.
This statistic is simply unthinkable: Only 3%, 30 out of the 994 soldiers identified as Migraineurs, were treated with triptans. Triptans are Migraine abortive medications that work in the brain to stop the Migrainous activity and all the associated symptoms. They work for at least 80% of Migraineurs, and for that 80%, they are considered the "gold standard" of Migraine treatment. It is appalling to send our men and women into combat zones to risk their lives for another country and its citizens, yet not give them something as simple as triptans to combat their Migraine attacks.
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Resources:
- Theeler, Brett J.; Erickson, Jay C.; Mercer, Renee. Department of Neruology, Madigan Army Medical Center; Fort Lewis, WA. "Prevalence and Impact of Migraine Among U.S. Army Soldiers Deployed to a Combat Theater." Research Poster Presentation. 48th Annual Scientific Meeting of the American Headache Society. Los Angeles. June 23, 2006.
- Interview: Captain Brett J. Theeler, MD, and Michael John Coleman, Executive Director of MAGNUM, the National Migraine Association. June 26, 2006.
