Exposure to terror may increase the risks of persistent weekly and daily migraine and tension-type headaches (TTHs) in adolescents above the levels expected, according to results published in Neurology. This result led researchers to conclude that clinicians may need to intervene after severe psychological trauma to prevent headaches from becoming chronic.
“We know a lot about the psychological effects of terror attacks and other extreme violence on survivors, but we don’t know much about the physical effects of these violent incidents,” said study author Synne Øien Stensland, MD, PhD, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo.
“Our study shows that a single highly stressful event may lead to ongoing suffering with frequent migraines and other headaches, which can be disabling when they keep people from their work or school activities,” added Dr. Stensland.
On July 22, 2011, a single gunman opened fire at a summer camp for adolescents on the Utøya islet, Norway, killing 69 people. Researchers invited all 358 survivors, who were aged 13 to 20 years old, to participate in the Utøya interview study.
In all, 213 teenage survivors (59%; mean age: 17.7 years; 49% male; 6% severely injured) agreed to participate. Researchers interviewed all subjects about headaches 4 to 5 months after the attack, gathering information about headache type and frequency, and comparing the answers to responses from 1,704 young age- and sex-matched controls from the population-based Young-HUNT3 Study who had not experienced terror. The semi-structured interviews also included a validated headache interview, corresponding with the International Classification of Headache Disorders.
Main outcomes of the study were recurrent migraine and TTHs over the past 3 months.
Dr. Stensland and colleagues found that exposed teens were four times more likely to have migraine headaches compared with controls (OR: 4.27; 95% CI: 2.54-7.17), and three times more likely to have frequent TTHs (OR: 3.39; 95% CI: 2.22-5.18). Even after adjusting for injury, sex, previous exposure to physical or sexual violence, and psychological distress, these findings remained.
In females, 73% of those exposed to terror had recurrent headaches, compared to only 37% of those who had not. In males, 41% who had been exposed to terror had headaches compared to only 19% of those who had not. Finally, terror survivors were much more likely to have daily or weekly headaches compared with those who were not exposed.
“We suspected that headaches would increase for terror survivors, and the increase was over and above what might be expected based on psychological distress and other risk factors,” said Dr. Stensland.
“This suggests that we may need to figure out ways to help people right after events like terror attacks to help reduce the potential of frequent and disabling headaches. In many cases with severe headaches, treatments can be most helpful early on before the condition becomes chronic,” she concluded.
In an accompanying editorial, Geoffrey L. Heyer and Kenneth J. Mack wrote: “Headaches and stress go hand in hand. Most individuals with a primary headache disorder perceive triggers for their attacks, and emotional stress is the trigger most commonly reported. Daily perceived stress correlates temporally with daily migraine activity. There may be a reciprocal relationship between migraines and stress whereby each influences the other over time. An association also occurs between perceived stress intensity and primary headache frequency. Even early childhood stressors such as trauma and neglect may predispose an individual to headaches later in life.”