A case for recognizing the consequences of traumatic head injuries—and developing support systems for people who suffer
The land mine blast ripped off his helmet cover, coming at him in fiercely powerful waves. In the helicopter he awoke dizzy, gagging, and with a terrible headache. He remembered nothing. He was hospitalized for three days and returned to combat 10 days later. For a month, the headaches persisted. He then sustained three other injuries within 36 hours—he survived a mortar shelling; an anti-tank mine rolled his Humvee over; and a roadside bomb exploded under his Humvee, slamming his head against the steering wheel. His headaches became extreme and continuous. He was medically discharged.
In earlier eras, this soldier probably would have been dead, but in modern war, improvements in protective gear are saving so many lives like his. The head injuries sustained by this soldier are a common kind of residual damage. They even have a medical name, Traumatic Brain Injuries, or TBIs—which leave members of our military with debilitating migraine headaches that go on long after they return to civilian life.
This is a different kind of headache—a type that originates in nerves damaged by the twisting and shearing action of combat or by "overpressure," blast waves that come off bombs at twice the speed of sound and compress everything in their wake. The problem is surprisingly common: About one-third of returning soldiers say they have migraine pain in the first months after coming home. In 2009, there were almost 23,000 active-duty soldiers with TBI. These highly disabling migraines represent the most common reason for service women and men to seek a neurologist's care. Yet these headaches are often poorly understood by friends and family—and medical professionals often don't know how to treat them.
There are federal guidelines for assessing these injuries, but they are vague and often require documentation of these injuries before soldiers can get treatment. It took until last year to require that the Secretary of Defense develop and implement a policy on pain management in the military health care system "including pain attributable to central and nervous system damage characteristic of injuries incurred in modern warfare, brain injuries, and chronic migraine headache." Unfortunately there is no infrastructure in either military or civilian life to conduct academic or clinical research on these conditions, and a lack of training for physicians in the future of headache medicine both in and out of the military.
For me, migraines are not abstractions. I am one of the 36 million Americans who suffer from them. Migraines have sent me to the emergency room, and they have locked me in seclusion, unable to think straight and plagued with nausea. Seemingly intolerable sounds, smells, and activities of life outside my room are second to the pain. It is a raw, relentless pain that makes you want to disappear or beat your head. It makes you wonder how long it will go on—and how long until it returns.
Two years ago I "went public" about my migraines. When I did, I learned the saddening statistics about migraines, not just in the military but among the general public as well. I pledged myself to promoting awareness of the condition and facilitating progress in its research and treatment. The United States spends little on migraine research. The National Institutes of Health allocates less that $13 million a year—which should be more like $260 million, considering the burden the disease carries.
I have promised to work everywhere in this country to raise awareness of the need for more research. We need to create integrated research networks that can bring together doctors and researchers from a number of fields to share information and collaborate on solutions. Today, such centers abound for many critical diseases. Not one exists for migraines.
The brave men and women in our military are suffering along with millions of other Americans, with no real hope of help on the horizon. We need to raise awareness and fund research. And if we can't find a cure, we owe it to them to find effective treatment.
Image: Sharif Karim/Reuters