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Headache Keeps Soldiers out of Active Duty

Headache is one of the leading reasons behind U.S. troops in Afghanistan being evacuated for medical reasons and is a leading contributor to the depletion of active-duty troops there. The same was true in Iraq, until the war ended recently.

These findings, published online in October in Cephalalgia, are the result of a study led by Steven P. Cohen, MD, an associate professor of anesthesiology and critical care at the Johns Hopkins University School of Medicine and a colonel in the Army Reserves.

Cohen and his colleagues reviewed the medical records of the 985 military personnel medically evacuated from Iraq and Afghanistan because of a primary diagnosis of headache between 2004 and 2009.

They found that two-thirds of those who left because of headache never returned to active duty. Those most likely to return were officers, with less physically demanding positions, and women, who are less likely than men to fill combat roles.

Just 20% of personnel whose headaches were attributed to trauma returned to active duty, while nearly half of those with tension headache were able to do so.

Post-concussion headache and migraine led the list of the type of headache that required soldiers to be evacuated; post-trauma headache accounted for nearly half the headache-related evacuations.

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

Dr. Cohen noted that a large number of headaches stemmed from the heavy Kevlar helmets, which put pressure on the occipital nerve in the back of the head. He recommends a better helmet design to prevent that type of headache. He also recommends better guidelines for managing headache to help retain soldiers on active duty.

“Headaches can be really tough to manage,” he said. “When people have bad headaches, they often can’t think or work. They’re incapacitated. That doesn’t work in a war zone.”

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