09/04/2024
BETA-BLOCKERS MAY BE TROUBLE IN SERVICES MEMBERS WITH MIGRAINE
In modern warfare, the primary causes of unit attrition have never been combat injuries. In fact, in both World Wars I and II, respiratory and infectious disorders were ranked as the top two causes of hospitalizations. Neurological disorders, including headache, ranked fifth. In Operations Iraqi Freedom and Enduring freedom, non-battle musculoskeletal injuries accounted for more injuries than any other injuries; however neurological illness - including headache - rose to the second leading cause of non-combat-related unit attrition.
Migraine is common in service members. In the U.S. migraine occurs in 10-15% of the general population and rises up to 30% in U.S. service members. Furthermore, almost 25% of migraineurs with post-traumatic stress disorder (PTSD) report combat as the most significant traumatic life even associated with their PTSD.
(Note: Post-traumatic stress disorder (PTSD) occurs as a result of exposure to extreme traumatic stressors that arouse feelings of intense fear, helplessness, and horror. As a result of these stressors the individual’s response characteristically involves re-experiencing the event emotionally, numbing or flattening of affect, and avoidance of stimuli that are associated with the event and increased arousal.)
PTSD is common in service members and in those with migraine. While PTSD occurs in about 8% of the general population, PTSD has been estimated to occur in 30% of those with migraine, 20% of service members not seeking treatment, and up to 50% in service members seeking treatment.
The high prevalence rate of migraine in service members and the strong association between migraine and PTSD, should be given serious consideration, particularly in regards to those being considered for return to combat. In a study led by Dr. Steve Cohen at Johns Hopkins, the use of beta-blockers was the factor most strongly associated with a failure to return to duty, even more so than opioid use and traumatic brain injury. It has been hypothesized that that this may be due greater disease burden from the medical indications triggering the use of beta blockers (e.g. migraine, PTSD, hypertension) OR even the medication itself (i.e. beta-blockers) which predispose the patients to even greater vulnerability to develop PTSD. Regardless of the reason for the use of beta blockers being associated with failure to return to duty, it is important for clinicians treating migraine, and service members seeking care for migraine, to consider migraine preventives other than beta-blockers for migraine prevention.
Peterlin et al. Cephalalgia. 2011;31(2):235–244. Post-traumatic stress disorder, drug abuse and migraine: New findings from the National Comorbidity Survey Replication(NCS-R)
Peterlin BL, Williams MA, Rapoport AM. Comment on : Headaches during war: analysis of presentation, treatment, and factors associated with outcome. (Letter to the Editor) Cephalalgia 2012;Oct;32(13):1009-10. [Commentary]
Cohen SP et al. Headache during war: analysis of presentation, treatment, and factors associated with outcome. Cephalalgia 2012;32(2):94-108
Ramchand et al. Disparate prevalence estimates of PTSD among service members who served in Iraq and Afghanistan: possible explanations. J Trauma Stress 2010;23(1):59-68.
PHC is a non-narcotic, headache center founded by author and clinician-scientist, Dr. Lee Peterlin. PHC is dedicated to improving the lives of those with headache disorders.
