Rep. Michele Bachmann moved quickly to address concerns about her health Wednesday, releasing a note from a physician declaring her in “overall good health” despite suffering from migraines that must be controlled with medication.

Brian P. Monahan, the House’s attending physician, wrote that he and a neurologist had evaluated Bachmann (R-Minn.) and found that the headaches were “infrequent” and well controlled.

The assessment was issued in response to reports that surfaced this week in which former aides, quoted anonymously, said the attacks are frequently incapacitating, raising questions about whether Bachmann is fit to serve as commander in chief.

Those questions, the latest in a series of controversies that have flared up in her campaign recently, present the first real test of Bachmann’s ability to weather the rigors of a modern presidential campaign.

They come at a critical juncture for her presidential bid, which has gained momentum since her strong showing in a debate last month, when she emerged as a top-tier candidate. A Washington Post-ABC poll released Thursday shows her running strong among Republicans, behind Mitt Romney, and other polls indicate that she is a front-runner in Iowa, whose caucuses are the first test of the primary season.

Bachmann has a chance to cement that standing with a strong showing in next month’s Iowa straw poll. That depends to some extent on whether release of the doctor’s note allows her to move beyond the focus on her health.

The note, dated Wednesday, confirms that doctors conducted brain scans and lab work and prescribed two types of medication that she takes when symptoms arise. It wasn’t clear when the scans and lab work were conducted.

“You have not needed medical attention from me regarding your migraines with the use of the above mentioned commonly used therapies,” Monahan wrote.

As she campaigned in a supporter’s back yard in Norwalk on Wednesday morning — a “beautiful, bright, sunny, wonderful, God-kissed morning in Iowa,” she exulted — many of the Republicans gathered said it wasn’t the headaches that would signal her fitness for office, but how she deals with the pressure.

“How she handles it is important,” said Kay King, 69, a retired small-business owner from Prole. “Whether or not she gets a migraine? We have to keep focused on what’s important here.”

But one of her opponents, former Minnesota governor Tim Pawlenty, suggested Wednesday that the headaches might preclude her from serving in the White House. At a campaign event Wednesday at a sports bar in Indianola, Iowa, Pawlenty said that candidates must show they can do “all of the job, all of the time.”

At a campaign stop in Southern California, Romney defended Bachmann. “There’s no question in my mind that Michele Bachmann’s health is in no way an impediment to her being able to serve as president,” Romney said.

News of Bachmann’s migraines surfaced Monday in the Daily Caller, which credited the information to three anonymous sources. According to the Web site, Bachmann had previously been hospitalized for the headaches, which the aides said were stress-induced and caused her to be out of commission for days.

Former aides contacted by The Washington Post gave their own accounts, with two saying that, although they knew she suffered from headaches, they did not appear to interfere with her work.

“There were a couple of times when she gave speeches while she was suffering from migraines, and she performed very, very well,” said Julie Quist, Bachmann’s former district director and a friend, who worked in one of her Minnesota offices from 2008 until March. “She deals with it, rises above it, and over the months that I was there, it was becoming more manageable.”

A third former aide said that Bachmann had attacks every few weeks, sometimes causing her to go home in the middle of the day and miss appointments.

“She would routinely just disappear, wouldn’t answer her phone, wouldn’t respond to
e-mail, nothing,” said the aide, who spoke on the condition of anonymity to speak candidly. “All of us [in the office] would just sit there and cover for her because we didn’t know what happened to her.”

The aide said that the decision to come forward was prompted not by support for another candidate but rather by concern for Bachmann’s overall readiness for the White House.

The issue has threatened to overshadow Bachmann’s economic message and her opposition to raising the nation’s debt limit.

Other controversies also have arisen in her five-week-old campaign. Last week, her husband, Marcus Bachmann, was forced to acknowledge after an undercover investigation by a gay rights group that his Christian-based counseling center provides a controversial therapy aimed at helping gay people change their sexual orientation.

Bachmann was criticized for signing a pledge drawn up by a socially conservative Iowa group that said black babies were more likely to be born into two-parent families under slavery than under President Obama. The criticism by African American groups intensified this week after she condemned a federal settlement with black farmers over past discriminatory practices.

Bachmann, a third-term congresswoman who has cultivated a reputation as a tea party outsider and Christian culture warrior, is in her first national campaign and has never run a statewide contest, which would have subjected her to more attention and vetting.

“She comes from an unapologetically religious family, and that will open up a lot of questions that get at her moral fiber and her personal life,” said Terry Holt, a Republican strategist who runs a public relations firm.

Still, Bachmann likes to boast about her “titanium spine.” This week on the campaign trail, she put it to the test. Before the campaign released the physician’s letter, one reporter asked about the migraines, and her press secretary stepped in front of Bachmann to block her from answering.

“Let me just answer this,” Bachmann said. “I gave a statement [Tuesday]. We were voting last night in Washington, D.C. We got here about one o’clock in the morning. I keep a very rigorous schedule. I feel great. And so we’ve answered that. . . . What I’m here to talk about is the debt ceiling.”

The doctor’s letter says that Bachmann’s headaches occur “with aura,” a sensation that signals a headache is about to begin.

She is taking two drugs, according to the letter. One, sumatriptan, is the original member of a family of drugs, the triptans, that transformed treatment of migraines two decades ago. It blocks the release of substances that cause the swelling of blood vessels and other steps in a cascade of events in the brain that lead to intense pain. Patients can inject themselves with the drug for relief that can start within 10 minutes. Most prefer to take it in pill form and wait about a half-hour for it to start to work.The other drug, ondansetron, is used to prevent nausea and vomiting and is sometimes used by migraine sufferers.

Migraines are more common and more severe in women than in men. Worldwide, at least 324 million people suffer from them, according to the World Health Organization.

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Somashekhar reported from Washington. Staff writer David Brown in Washington contributed to this report.