Mental Health Screening Advised for
Iraq War Veterans With Migraines

BY MARYJO M. DALES
Elsevier Global Medical News

BOSTON (EGMN) - In soldiers returning from combat in Iraq, a self-reported history of migraine headaches was associated with at least twice the risk of symptoms of depression, posttraumatic stress disorder, and anxiety as was seen in similar soldiers without migraines, based on a study presented at the annual meeting of the American Academy of Neurology.

Migraines appear to be frequently associated with symptoms of psychiatric conditions in soldiers returning from deployment, Maj. Jay C. Erickson, MC, USA, said during a press conference on May 2 at the meeting, where the study results were presented during a scientific poster session. Although all soldiers returning from deployment undergo mental health screening, there is the possibility that headaches and symptoms of a psychiatric condition could present after such testing and possibly outside the Veterans Affairs health care system, he said. Mental health screening is warranted to assure that psychiatric disorders are identified and properly treated at that time.

Dr. Erickson, of Madigan Army Medical Center at Fort Lewis in Tacoma, Wash., reported the findings from a health screening questionnaire completed by nearly 2,200 of 3,600 soldiers returning to Fort Lewis in Washington state after a 1-year combat duty deployment to Iraq. The questionnaires, completed within 90 days after the soldiers' return, indicated that nearly 20% had migraine headaches.

The study results are limited by their self-reported nature, which does not establish a diagnosis and is likely to result in more reports of symptoms; they also are limited by a lack of information about predeployment rates of migraine. Nevertheless, the rates are twice those seen in 20 to 40 year olds in the general population and in men, who comprised 96% of the study participants.

Respondents answered 15 questions about the nature and frequency of any headaches in the last 3 months. They also completed the four-question Primary Care PTSD Screen (PC-PTSD) and the Patient Health Questionnaire (PHQ9) screen for depression and anxiety. The respondents were 27 years old, on average, and 90% were enlisted soldiers.

The responses indicated that 32% had symptoms of depression, 22% screened positive for PTSD, and 9% screened positive for anxiety. Overall, 39% of the respondents had at least one psychiatric condition. Respondents with migraines, compared with those without migraines, had much higher rates of depression symptoms (50% vs. 27%), symptoms of PTSD (39% vs. 18%), and anxiety symptoms (17% vs. 7%).

The number of migraine days per month was associated with a higher probability of a positive screen for depression and PTSD, but not a higher rate of anxiety symptoms. Those with migraine and depression symptoms had an average of 3.5 headaches days per month, compared with 2.5 days for those with migraine and no symptoms of depression.

A link between migraine and a two- to threefold higher risk for depression in the general population is already established by other investigators, but soldiers specifically had not been studied. "We purposely set a low threshold for a positive screen, because we did not want to miss any soldiers with health problems," Dr. Erickson said. "We don't know the incidence of symptoms in nondeployed soldiers." He noted that planned studies will address the frequency of migraines in military populations and will follow their outcomes in a prospective fashion.

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