The 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 Ready, MD, later suggested the pain was perpetuated or worsened by post-traumatic 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
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 nightmares, 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.
“People with migraine have a hypersensitive, hyper-vigilant nervous system,” he says. “I think it’s easier for people who have that underlying sensitive brain to end up developing PTSD.”
Conversely, stressful events will actually cause bio- chemical changes in the brain, and aspects of PTSD—including nightmares that disrupt sleep—make it difficult for the brain to relax. Dr. Ready says this could worsen the underlying migraine condition. In addition, mild traumatic brain injuries—the defining wound of the wars in Iraq and Afghanistan— are almost always linked to headaches and are often associated with PTSD.
It Is Treatable
Research has shown that people who suffer from both PTSD and migraine are more likely to have headache-related disability, so it is important to seek treatment as soon as possible. In addition to taking traditional migraine medications, such as triptans, sufferers need to address the psychological component with therapy.
“If we treat the PTSD, the pain gets better,” Dr. Ready says. “It doesn’t necessarily go away, but it’s an essential part of what we need to do.”
Certain lifestyle changes, such as exercise, improved diet and increased hydration, are also beneficial. Dr. Finkel notes that maintaining proper sleep, as well as managing the patient’s environment, are particularly important.
“People with PTSD may feel very uncomfortable in crowds and in an unsafe environment,” he says. “That kind of stress can lead to more headaches.”
As researchers continue to explore the relationship between PTSD and migraine, Dr. Ready hopes their findings serve as a wake-up call for both physicians and veterans.
“If you’re having frequent headaches, I think it’s important to ask, ‘Could I have PTSD with this?’” he says. “Because if it’s there and we don’t treat it, chances are it will make it harder to get your headaches under control.”
For Nunnery, working with his physician, spending time at the gym and practicing tai chi have helped significantly reduce his migraine events.
“If you have PTSD, don’t deny it,” he says. “It was hell until I started getting help…now I almost have a normal life again.”
Resources for Recovery
Addressing the symptoms of PTSD can reduce related migraine pain. To help with this, Michael ready, MD, recommends book therapy.
“With any kind of chronic condition, the more we learn about it, the better we do,” he says. He suggests the following two reads:
- The Post-Traumatic Insomnia Workbook: A Step-By-Step Program for Overcoming Sleep Problems After Trauma by Karin Elorriaga Thompson, PhD, and C. Laurel Franklin, PhD
- Brain Injury Survival Kit: 365 Tips, Tools and Tricks to Deal with Cognitive Function Loss by Cheryle Sullivan, MD
Don’t have time to dive into a book? Try this mobile solution created by the U.S. Department of Veteran Affairs and the Department of Defense:
- PTSD Coach: This smart phone app offers PTSD treatment information, tools for tracking symptoms, tips for handling stress and links to support—all at your fingertips. You can download PTSD Coach for free from iTunes or Android Market.
And be sure to check out a variety of resources for war veterans on the National Headache Foundation website.
By the Numbers
- Male migraineurs are four times more likely than female migraineurs to have PTSD.
- Veterans with migraine are twice as likely to have PTSD, depression and anxiety than those without migraine.1
Reference:
1. American Academy of Neurology
