New Onset Migraine Associated With a Civilian Burn Pit

Deployed service members exposed to burn pit smoke can experience a multitude of symptoms. Respiratory symptoms after burn pit smoke exposure are well recognized, but neurologic symptoms are less well recognized. There are reports of migraines triggered by odors but no specific reports of new onset migraines triggered by exposure to burn pit smoke. Clinicians encountering patients with new onset migraines in the deployed setting face the dilemma of evacuating the patients to perform neuroimaging or keeping them in theatre.

Retrospective case series study and review of the literature.

Three patients with new onset headache after exposure to open burn pit smoke are described. The headaches met established criteria to be classified as migraine with aura in two patients and migraine without aura in one patient. The migraines were triggered by exposure to the burn pit smoke and relieved by avoidance of the smoke. The patients did not have history of migraine and had normal neurological examinations. Computed tomography performed in one patient and optic nerve insonation performed in all three patients were normal. The patients responded well to triptans and antiemetic medicines.

Nociceptive odors can trigger classic migraines in adults without prior history of migraine. The temporal association between exposure to the odor and the development of the headache, the absence of abnormalities on neurologic examination, and the response to triptans help establish the diagnosis. Activation of the trigeminal system leading to release of pain-related neuropeptides may mediate the migrainous symptoms. Evacuation for advanced neuroimaging or specialized consultation can be avoided if the above-mentioned criteria are met.