War zone headaches can lead to troop shortages

Headaches are one big reason that troops in Iraq and Afghanistan are medically evacuated, and because they only about a third return to duty in those countries, it’s depleting active-duty ranks. This is according to a new study lead by Dr. Steven P. Cohen, an associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine and a colonel in the U.S. Army Reserves.

“Everyone gets headaches, and there are generally physical or psychological stressors that contribute to them,” he said in a statement. “War amplifies all stressors, which may be why headaches take such a great toll in soldiers overseas.”

For the study, published online in Cephalalgia, the journal of the International Headache Society, Cohen and other researchers looked at the medical records of all 985 military personnel medically evacuated from Iraq and Afghanistan between 2004 and 2009 with a primary diagnosis of headache.

In general, neurological illnesses such as headaches are one of the top three causes of non-combat related loss of unit strengths in those war zones. Half of the headaches studied were the result of physical trauma and only one in five of the sufferers returned to duty. Half who were evacuated with tension headaches went back to the war zone. Those with psychiatric illness or traumatic brain injury or were treated with narcotics were the least likely to return.

Some headaches resulted from damage to or pressure on the occipital nerve in the back of the head, possibly caused by the heavy Kevlar helmets worn in war zones.

Headaches can make it hard to think and work, said Cohen, also director of chronic pain research at Walter Reed National Military Medical Center. He said military doctors need to understand their impact and make an effort to treat them on the ground. Better design of helmets could also reduce some strain.

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