Men and women veterans who acknowledged being victims of sexual trauma while serving in the military had a higher risk of migraine and other pain-related complaints, researchers reported at the virtual annual scientific meeting of the American Headache Society.
John P. Ney, MD, MPH, assistant professor of neurology at Boston University, and colleagues analyzed administrative data from the Women's Veteran's Cohort Study, a sample of more than one million post-9/11 US veterans enrolled for Veterans Health Administration (VHA) care. A positive military sexual trauma screen in the VHA electronic medical record defined exposure.
Out of more than 800,000 veterans who were screened for the study, 37,375 were positive for military sexual trauma; approximately 66 percent were women and 34 percent men, Dr. Ney said. Overall, migraine was reported in 21.7 percent of veterans with a history of military sexual trauma compared with 9 percent of the veterans who did not report sexual trauma, said Dr. Ney.
Dr. Ney said that treatment of persons with migraine who have a history of military sexual trauma may vary from recommendations. "We found that these persons were more often using acute health care resources such as emergency departments for treatment of their migraines and were more prone towards using medications that were not recommended by the AAN and AHS for headache treatment, which may ultimately be deleterious to their care.
Among the 80,696 veterans diagnosed with migraine headache, a history of military sexual trauma was associated with a significant 37 percent greater likelihood of ambulatory urgent/emergent care, a 10 percent greater likelihood of neurology visits, and a 21 percent greater likelihood of physiatry visits.
Notably, Dr. Ney said, the dataset includes both male and female former service members reporting military sexual trauma, albeit with a much lower reported rate in men. "We are confident that the identified cases are true positives, though the number of false negatives is likely to be large," he said.
"Although veterans in their course of care through the VA are asked questions regarding military sexual trauma, we believe that any attempts at determining prevalence will likely be an undercounting of the true numbers."
"Our study can only show the association of military sexual trauma with migraine, but it does not purport to show causality, that migraine is 'caused by' or a 'manifestation of' sexual trauma," Dr. Ney told Neurology Today At the Meetings. "Having said that, migraine is a very common phenomenon, and most men and women who have served in the military are in the age category where migraines occur."
"Migraines are exacerbated by poor sleep, and prior studies show associations with psychiatric conditions from stress, including post-traumatic stress disorder," he said. "Military sexual trauma may precipitate a similar phenomenon, and headaches or other pain syndromes may be unmasked by the sequalae of sexual trauma."
These numbers may not tell the whole story, Dr. Ney said. "Even in 2020 there is considerable stigma to admitting to being sexually victimized in society, and likely more so in the military, that prizes strength and physical prowess in its members," he said.
"All active duty and veterans should be asked about military sexual trauma regardless of their health or disease conditions," Dr. Ney said. "Within the VA, it is mandated nationally to screen for military sexual trauma within primary care. At the same time, we are working to identify treatment modalities that are especially successful in the care of persons living with migraine and military sexual trauma."
Commenting on the study, Nina Riggins, MD, assistant clinical professor of neurology at the University of California, San Francisco, suggested that there are biological mechanisms that may be associated with both sexual trauma and migraine. "Migraine is a genetic neurologic disorder," she told Neurology Today At the Meetings.
"Multiple brain networks can be affected. Dysfunction of several systems is possible after sexual trauma, including the serotonergic, autonomic nervous system and hypothalamic-pituitary-adrenal axis, which is involved in response to stress. Stress, insomnia, hormonal changes, and serotonergic dysfunction can trigger migraine."
Dr. Riggins noted that the investigators reported a 9 percent prevalence rate of migraine in the gender-adjusted group without military sexual trauma. "We know that migraine affects about 12 percent of the population in the United States. We need to conduct more studies to see if sexual trauma is under-reported and accounts for at least some of this difference."
Dr. Riggins added, "Knowing the history and triggers can help to guide treatment options for these individuals with migraine. It is important to avoid opioids when possible in people living with migraine. The combination of behavioral therapy, migraine management, and addressing any other conditions potentially connected to sexual trauma, can be beneficial for improvement of functioning, symptoms, and quality of life."
Disclosures: Drs. Ney and Riggins had no relevant disclosures.
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AHS Abstract: Ney JP, Fenton BT, Sico J, et al. Survivors of military sexual trauma face increased risk of migraine headaches and worse headache care.