It’s painful to recall the 2011 mass shooting in a summer camp in Sweden during which a lone gunman shot to death 69 teens. All of the 362 survivors were exposed to extreme terror trying to escape and dealing with the loss of friends. Among the survivors, 213 (60%) participated in a study to determine if they had a higher risk of developing headaches. Among the girls, 45% vs 13% of a control group had daily or at least weekly headaches. Among the boys, it was 15% vs 4% for the controls.

Many studies have shown an association between repetitive or daily stress and migraine or tension-type headaches. Early childhood trauma or neglect is a strong predictor as well. But rarely can a single event of extreme psychological trauma have the same effect.

What’s the mechanism? It has been known for many years that stress triggers biological changes in the hypothalamic-pituitary-adrenal axis such as increased cortisol production or activation of the autonomic nervous system. Neurotransmitters such as serotonin, dopamine and endorphins are affected as well. Even subtle daily stressors probably can cause maladaptive persistent changes, which include effects on certain genes and connectivity in brain networks that mediate pain. Now we know that a single horrific event can do the same.

See Neurology, Vol 90, page 59. Lead author is Stensland. The editorial comment is by Heyer, page 53-54.

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