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Headache as a predictive clinical marker for combat-related PTSD risk
Melanie Shanie Roitman1, Erez Magiel2, Gabriel Ricardo Lichtenstein2,3
1Department of Neurology, The Sheba Medical Center, Tel HaShomer, Ramat Gan, 52621, Israel. Melanie.Roitman@sheba.health.gov.il.
Social Psychiatry and Psychiatric Epidemiology
|June 1, 2026
Summary
Pre-enlistment headache is linked to higher odds of developing post-traumatic stress disorder (PTSD) after combat trauma. While a significant predictor, headache history alone has limited screening utility for PTSD risk.
Area of Science:
- Psychiatry
- Neurology
- Epidemiology
Background:
- Only a fraction of trauma-exposed individuals develop post-traumatic stress disorder (PTSD).
- Pre-existing characteristics may influence PTSD risk.
- The predictive value of pre-trauma physical symptoms like headache is not well-established in large populations.
Purpose of the Study:
- To investigate the association between pre-enlistment headache and subsequent combat-related PTSD.
- To assess headache as a potential predictive clinical marker for PTSD risk.
Main Methods:
- Retrospective cohort study of 1,126,651 Israeli military conscripts (1998-2019).
- Headache history documented at enlistment; PTSD diagnoses from psychiatric registries.
- Logistic regression analysis adjusted for covariates; predictive performance evaluated.
Main Results:
- Pre-enlistment headache reported by 4.37% of participants.
- Headache associated with increased odds of PTSD (OR=1.32), particularly in women.
- Headache showed statistically significant but modest predictive discrimination (AUC=0.55).
Conclusions:
- Pre-enlistment headache is an independent clinical marker for elevated PTSD risk post-combat trauma.
- Headache history has limited utility as a standalone PTSD screener.
- Integrating neurological history into multifactorial models may enhance identification of high-risk individuals.
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