Veterans and Headache Disorders

People who serve in the armed forces are often among the toughest people you’ll ever meet, but that doesn’t shield them from migraine disease and other headache disorders. In fact, service members may develop headache disorders from exposure to risk factors civilians seldom face—like explosions! However, thanks to medical advances and increased public awareness, current and former service members now have better treatment and support options than ever before.

Headache Is Prevalent Among Military Personnel

According to the United States Department of Veterans Affairs (VA), 16% of all veterans receiving care through the Veterans Health Administration (VHA) have at least one headache disorder.^1,2 Between October 2007 and June 2024, the VA diagnosed and treated more than 2,100,000 veterans for headache.¹ Migraine is among the top ten most common service-connected disability claims filed with the U.S. Department of Veterans Affairs.

Headache Risks for Military Personnel

A primary headache disorder is not caused by an underlying condition (as in most cases of migraine). In contrast, a secondary headache disorder results from another condition—for example, post-traumatic headache is caused by a head injury.

Although primary headache disorders can affect anyone, military personnel are far more likely than most civilians to be exposed to certain risks associated with secondary headache disorders:

Traumatic brain injury

Service members are more likely than the average civilian to experience traumatic brain injury (TBI) from impact. Service members in combat areas may experience impact-type head injuries from physical contact with others, vehicle accidents, falls, or flying debris from explosions or other projectiles. Service members are also at risk for mild traumatic brain injuries (mTBIs), like “mild” concussions. Mild traumatic brain injuries often lead to headache, especially in people who accumulate multiple mTBIs.

Burn pits

Until the mid-2010s, U.S. military bases in Iraq, Afghanistan, and other locations regularly disposed of waste in burn pits, some of which covered several acres. Items in burn pits included rubber, plastics, chemicals, medical waste, and other items known to emit toxic smoke and fumes. During the GWOT era, service members began reporting a variety of serious health problems that were eventually traced to burn pit exposure. The U.S. Department of Defense (DOD) estimates that nearly 3.5 million troops from recent conflicts may have received enough exposure to burn pit smoke and fumes to cause health problems.³

A 2024 study examined cases of service-connected headache in U.S. veterans on the DOD burn pit exposure registry who did not have prior headache diagnoses.⁴ Compared with veterans without burn pit exposure, those with the greatest exposure had higher rates of developing headaches of any type (55.8% vs 40.4%), including migraine (28.7% vs 18.2%).⁴

Blast waves

The danger from being close to an explosion isn’t merely the increased risk of injury from whiplash, burns, or being struck by heavy debris traveling in your direction at high speed. It’s also from an invisible but dangerous threat called a blast wave, a massive, rapid change in air pressure that follows an explosion.

Blast waves may disrupt and damage neurons (which transmit electrical signals, the primary job of the nervous system), glia (cells that protect neurons), and blood vessels.⁵ Blast waves may be large and intense from explosives like dynamite, but even repeated exposure to lower-level blast waves from equipment like shoulder-mounted missile launchers may be harmful. Experts believe that such exposure can damage the brain’s blood vessels, neurons, and protective barriers, triggering inflammation, reduced oxygen flow, and even cell death, which can lead to a cascade of serious and harmful neurological consequences.⁶

Although this area of research is still new, increasing evidence strongly suggests that service members and veterans with blast-related mTBI may be more vulnerable to long-term headache symptoms and associated consequences than veterans with mTBI from non-blast-related incidents.⁷

Treatment for Veterans with Headache

Living with migraine disease or other headache disorders is a challenge for any person, but it can be extra-complicated for veterans who have developed service-connected headache. Most veterans who develop service-connected headache have symptoms consistent with a diagnosis of migraine, although some may develop symptoms consistent with chronic tension-type headache, post-traumatic headache, cluster headache, or a combination of these headache disorders. About two-thirds of veterans treated for headache in the VA had at least one chronic pain condition, 50% had a sleep disorder, 38% had at least one mental health condition, 8% experienced sexual trauma, and 3% had a traumatic brain injury.¹

The good news is that new treatments and increased public awareness are improving the lives of veterans and civilians with headache disorders—and thanks to efforts by advocates and elected officials, veterans have increased access to experts and promising treatments than ever before.

Headache centers of excellence

In 2018, after years of efforts by headache advocates, the U.S. Congress passed an appropriations bill earmarking $10 million to create at least five headache centers of excellence (ultimately, seven were created) within the Veterans Administration (VA) health system, starting with locations that already had existing polytrauma and TBI operations.⁸ Since its inception, the Headache Centers of Excellence (HCoE) program has expanded to include 27 centers, each offering varying levels of headache-aware treatment.⁸ Only the so-called hub sites provide the full spectrum of specialty, multidisciplinary, and interdisciplinary care. This includes neurologists and other clinicians trained in headache medicine, health psychologists, clinical pharmacists, rehabilitation specialists, and complementary and integrative health providers. Other centers provide care from headache medicine–trained neurologists and some elements of interdisciplinary headache care, but do not offer the full range of services available at hub sites.⁸

The creation and growth of the HCoE program coincided with medical breakthroughs for new treatments for migraine disease. Thanks to these advances and the growth of the HCoE program, healthcare providers within the VA health system now have access to more resources, guidance, and professional support in treating veterans with service-connected headache disorders.  

Increased coverage for migraine-specific medications

Depending on a veteran’s headache history and diagnosis, several treatment options may be available. The VA can prescribe traditional acute medications, such as triptans, as well as various preventive treatments. Newer therapies are also accessible, including calcitonin gene-related peptide (CGRP) inhibitors, which can be used for both the acute and preventive treatment of migraine (one is also approved for cluster headache). Additionally, botulinum toxin injections and nerve blocks may be authorized for use. Some facilities may also offer complementary approaches, such as acupuncture, chiropractic care, or yoga.

Increased coverage for neuromodulation devices

One area in which the VA has excelled is the use of neuromodulation devices to treat headache disorders. These devices apply electrical or magnetic impulses to reduce, eliminate, or prevent migraine attacks. They are worn or held against different parts of the body to stimulate (or modulate) nerves or areas of the brain and nervous system involved in the migraine process. Between October 2016 and September 2023, more than 14,000 veterans with migraine were prescribed at least one device, a 160% increase in the use of neuromodulation devices.¹

Although neuromodulation devices show promise for treating headache disorders and many other conditions, they remain out of reach for many individuals due to high costs and limited insurance coverage. The VA, however, covers the cost of these neuromodulation devices (although individuals may need prior authorization to get them):

• Noninvasive vagus nerve stimulation (nVNS) device (gammaCore)⁹
• Remote electrical neuromodulation (REN) device (Nerivio)¹⁰
• Single-pulse transcranial magnetic stimulation (sTMS) device (SAVI Dual)¹¹
•  External trigeminal nerve stimulation (CEFALY)¹²

[Note: This information is updated through October 2025, but budget cuts and other changes at the federal level may affect access to providers and specific treatments.]

Operation Brainstorm

Operation Brainstorm™ is an initiative by the National Headache Foundation that supports service members, veterans, and their loved ones living with headache and migraine disease. The program offers educational resources on healthcare and disability benefits, guidance on navigating treatments, information on government programs, and more. Learn more about Operation Brainstorm here.

Help for Veterans With Headache Disorders

Veterans who experience head pain that doesn’t go away no longer have to “grin and bear it.” Current and former service members who develop service-connected headache disorders now have better access to comprehensive medical care and more treatment options than ever, thanks to progress in science and the efforts of headache advocates.

If you are a U.S. service member or veteran and you have developed headache attacks during or after your service, especially if you had mTBI incidents or exposure to burn pits or blast waves, please contact your primary care provider through the VA or DOD.

References

1. Alliance of Headache Disorders Advocacy webinar Serving Those Who Served: Inside the VA Headache Centers of Excellence, December 3, 2024, by Dana L. lonel, DO, Medical Director, Lexington VA Headache Center of Excellence and Jason J. Sico, MD, FAHS, National Director, Headache Centers of Excellence Program (HCoE), Department of Veterans Affairs Director.
2. https://www.va.gov/tennessee-valley-health-care/stories/migraines-and-headaches-understanding-the-disorders/
3. MilitaryTimes.com, What are military burn pits and why are veterans worried about them? Leo Shane III. March 29, 2022. https://www.militarytimes.com/news/burn-pits/2022/03/29/what-are-military-burn-pits-and-why-are-veterans-worried-about-them/
4. Sico JJ, Anthony SE, Phadke M, Wang K, Skanderson M, Ney JP, Seng EK, Shapiro RE, Sandbrink F, Scholten JD, Graham GD, Martini SR, Fenton BT. Open Burn Pit Exposure in Headache Disorder and Migraine. JAMA Netw Open. 2024 Sep 3;7(9):e2431522. doi: n10.1001/jamanetworkopen.2024.31522.  https://pmc.ncbi.nlm.nih.gov/articles/PMC11375476/
5. Edlow BL, Bodien YG, Baxter T, Belanger HG, Cali RJ, Deary KB, Fischl B, Foulkes AS, Gilmore N, Greve DN, Hooker JM, Huang SY, Kelemen JN, Kimberly WT, Maffei C, Masood M, Perl DP, Polimeni JR, Rosen BR, Tromly SL, Tseng CJ, Yao EF, Zürcher NR, Mac Donald CL, Dams-O’Connor K. Long-Term Effects of Repeated Blast Exposure in United States Special Operations Forces Personnel: A Pilot Study Protocol. https://pmc.ncbi.nlm.nih.gov/articles/PMC9529318/ 
6. Jon Hamilton. Blasts from military weapons may injure the brain through its blood vessels. All Things Considered. National Public Radio, January 23, 2025. https://www.npr.org/sections/shots-health-news/2025/01/23/nx-s1-5254492/blasts-from-military-weapons-may-injure-the-brain-through-its-blood-vessels
7. Miller AR, Martindale SL, Rowland JA, Walton S, Talmy T, Walker WC. Blast-related mild TBI: LIMBIC-CENC focused review with implications commentary. NeuroRehabilitation. 2024;55(3):329-345. doi: 10.3233/NRE-230268. https://pmc.ncbi.nlm.nih.gov/articles/PMC11612977/
8. https://allianceforheadacheadvocacy.org/wp-content/uploads/FINAL-VHA-Leave-Behind-v.9.pdf
9. https://www.stocktitan.net/news/ECOR/electro-core-extends-va-contract-for-five-zmphmt12b5zz.html
10. https://www.globenewswire.com/news-release/2025/04/22/3065465/0/en/Theranica-Announces-Coverage-Policy-from-the-Second-Largest-U-S-Health-Insurer-for-Its-Nerivio-REN-Wearable-Migraine-Treatment-Reaching-Access-for-80-Million-Americans.html
11. https://eneura.com/stms-migraine-therapy-for-veterans/
12. https://www.cefaly.com/veterans-migraine-relief?srsltid=AfmBOopUoi0YVqFUMK1rye2zKic1mnTVZau9gxSAfwz8Z5_Id86XMvWU

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