Unfortunately, terrorist attacks are becoming increasingly common. It’s not surprising that survivors of such horrific events suffer psychological trauma. New research is now finding that survivors can also suffer lasting physical effects apart from any injuries sustained in the violence.

Background: Stressful life events, including nonviolent occurrences, are potential triggers for migraine and tension-type headaches—possibly because the brain’s response to such stressful events changes the way pain is perceived and expressed. So when violent and life-threatening events occur, they may trigger onset of such headaches, especially when the terror is experienced during adolescence and young adulthood.

Study: Researchers at the Norwegian Centre for Violence and Traumatic Stress Studies and Oslo University Hospital studied 213 of the survivors of a 2011 terrorist attack at a summer camp on a small island in Norway. Although 69 people were killed and 33 wounded, everyone on the island either witnessed or was somehow exposed to the terror. Each adolescent survivor who was under the age of 20 at the time of the attack was compared with age- and sex-matched “control” subjects drawn from a large, previously completed population-based general health study. (The researchers excluded from the study anyone who sustained a traumatic brain injury as a result of the attack.) Both the terror-exposed group and the control group were interviewed several times over the three years of the study and were asked specifically about frequency and types of headaches experienced.

Results: Survivors of the terror reported more frequent headaches than the controls and were three times more likely to report chronic (weekly or daily) headaches, such as migraine, than controls. Less frequently occurring headaches (less than monthly) were reported equally by both groups. As expected, survivors also reported higher levels of post-traumatic psychological distress.

Bottom line: It is expected that terror incidents and other acts of violence are likely to cause physical and emotional scars among survivors, even those who were not injured physically. Now research is underscoring that surviving or even witnessing extreme violence can also hurt physical health.