The journal Headache recently published the results of a study of soldiers returning from Iraq and Afghanistan. The soldiers had suffered deployment-related concussions. Soldiers with chronic daily headache, defined as headaches occurring 15 or more days per month, for the previous 3 months were compared to soldiers with episodic headaches occurring less than 15 days per month.
Approximately 20% of the soldiers had chronic daily headache, while 78% had episodic headache. It was noted that the number of concussions, blast exposures, and concussions with loss of consciousness was not significant between the two groups. However, the soldiers with chronic daily headache had significantly higher average scores on the post traumatic stress disorder (PTSD) checklist compared to soldiers with episodic headaches.
The study concluded that PTSD symptoms were strongly associated with chronic daily headache, suggesting that traumatic stress may be an important point of headache chronification. A few years back John Rothrock, M.D. and editor in chief at Headache published an article asking the question “Why does migraine become chronic?” While he noted that are not clear answers, he suggested there may be a strong association between chronification and a history of early sexual abuse, and other emotional traumas early in life. It may be possible that PTSD and returning troops with head trauma may also have a link to chronic daily headache. While early emotional trauma (or sexual or physical), or in the case of soldiers the PTSD, may predispose to headache, this is not to say that the headaches are “all in your head”. They are very real, just like diabetes or asthma. These headaches involve many changes in neurological pathways and neurotransmitters.