Survivors of Military Sexual Trauma Face Increased risk of Migraine Headaches and Worse Headache Care

John P. Ney, MD, MPH

AHSAM 2020 - Oral session
Published on October 2, 2020 | NEW

3 minute listen
8 minute read

Key messages

  • Military veterans with military sexual trauma (MST) are more likely to suffer from migraine headaches.
  • They are more likely to require acute healthcare, including urgent care and emergency department visits for migraine headaches, and take pharmacotherapies discordant with recommended guidelines for migraine headache.
  • Background

    What do we already know about this topic?
  • Findings

    What does this study add?
  • Perspectives

    How does this study impact clinical practice?
  • Expert commentary

    by Gretchen E. Tietjen, MD

Key messages

  • Military veterans with military sexual trauma (MST) are more likely to suffer from migraine headaches.
  • They are more likely to require acute healthcare, including urgent care and emergency department visits for migraine headaches, and take pharmacotherapies discordant with recommended guidelines for migraine headache.

Background

What do we already know about this topic?

  • MST is defined by the VA as sexual assault or harassment occurring during military service.
  • Prevalence is estimated to range from 2–90% amongst the US military population.1 
  • Prior analyses have correlated MST with psychiatric disorders, substance abuse, and pain conditions, including migraine and headache.2,3
  • No large-scale studies have evaluated MST and migraine headache in a veteran population.

How was this study conducted?

  • A retrospective cohort study of 846,435 veterans extracted from the Women’s Veteran’s Cohort Study (WVCS) data set, that evaluated post-9/11 US veterans enrolled for Veterans Health Administration (VHA) care.
  • Exposure was defined as a positive MST screen in the VHA electronic medical record.
  • Outcome measures included prevalence of migraine, psychiatric and other pain co-morbidities, use of migraine headache treatments, and specialist physician and acute care usage.

Findings

What does this study add?

  • Migraine was more common in veterans with MST (21%, 8,102/37,375) than in veterans without MST (9%, 72,602/809,060)
  • Of the veterans with MST, a greater proportion of female veterans suffered from migraine (26.9%) than male veterans (11.7%).
  • Among veterans with migraine headache, MST was associated with a greater likelihood of ambulatory urgent/emergent care, neurologist visits and physiatrist visits.
  • Veterans with MST had significantly higher prevalence of comorbidities such as PTSD (61.7% vs. 39.9%), major depression (42.2% vs. 20.4%), and non-headache pain (80.9% vs. 73.3%) versus those without MST (p<0.0001).
  • Adjusting for gender and comorbid pain conditions, MST patients were more likely to receive headache abortive and preventative medications discordant with American Headache Society/American Academy of Neurology (AHS/AAN) guidelines, especially opioids.

 

Figure: Influence of MST on received migraine care

Perspectives

How does this study impact clinical practice?

  • Military veterans with MST are more likely to suffer from migraine headaches, accompanied by a greater number of co-morbidites.
  • They are more likely to receive emergency care for migraine headaches, and take pharmacotherapies discordant with recommended guidelines for migraine headache, including opioids.
  • Further studies are needed to quantify medication use, level of compliance, and utilization of non-medicinal therapies, as well as demand on acute and specialist healthcare.

Perspectives

How does this study impact clinical practice?

  • Military veterans with MST are more likely to suffer from migraine headaches, accompanied by a greater number of co-morbidites.
  • They are more likely to receive emergency care for migraine headaches, and take pharmacotherapies discordant with recommended guidelines for migraine headache, including opioids.
  • Further studies are needed to quantify medication use, level of compliance, and utilization of non-medicinal therapies, as well as demand on acute and specialist healthcare.

This is a highlights summary of an oral session given at the AHSAM 2020 Virtual Annual Scientific Meeting and presented by:

John P. Ney, MD, MPH
Medical Director, Specialty and Acute Care
Edith Nourse Rogers Memorial VA Medical Center
Bedford, Massachusetts

The content is produced by Infomedica, the official reporting partner of ASHAM 2020 Virtual Annual Scientific Meeting. The summary text was drafted by Goldcrest Medical Writing, reviewed by Marco Vercellino, MD, an independent external expert, and approved by Jessica Ailani, MD, FAHS and Mark J. Burish, MD, PhD, the scientific editors of the program.

The presenting authors of the original session had no part in the creation of this conference highlights summary.

In addition, an expert commentary on the topic has been provided by:

Gretchen E. Tietjen, MD
University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, U.S.

Gretchen E. Tietjen, MD
University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, U.S.

Dr. Gretchen Tietjen is a Distinguished University Professor Emerita of Neurology at the University of Toledo, where she specializes in headache medicine and vascular neurology. Her research focuses on the migraine-stroke association, and the relationship of early life stress and migraine, including the effects on vascular and brain biology.  Dr. Tietjen has over 150 papers, chapters, and reviews, and has been the recipient of the Stroke Innovation Award from the journal Stroke, and the Seymour Solomon Award, the Harold G. Wolff Award,  John Graham Award, and the Women's Health Research Award from the American Headache Society.

1. Wilson, L. C. The Prevalence of Military Sexual Trauma: A Meta-Analysis. Trauma, Violence, & Abuse 2018;19:584–597.

2. Cichowski SB, Rogers RG, Clark EA, et al. Military Sexual Trauma in Female Veterans is Associated With Chronic Pain Conditions. Military Medicine 2017;182:e1895–e1899.

3. Seng EK, Driscoll MA, Brandt CA, et al. Prescription headache medication in OEF/OIF veterans: results from the Women Veterans Cohort Study. Headache 2013;53:1312-1322.



Headache
Migraine


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