Prevalence of Headache and Comorbidities Among Men and Women Veterans Across the Veterans Health Administration – a 10-year Cohort Study

Brenda Fenton, PhD, M.Sc

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

7 minute
5 minute

Key messages

  • Headache is common amongst veterans in the Veterans Health Administration (VHA), with ‘headache not otherwise specified’ being the most common type, suggesting a need for physician headache diagnosis training.
  • Pain and psychiatric comorbidity is extremely high, indicating high patient complexity and a need for interdisciplinary headache treatment.
  • Although less than 1% of men and women were diagnosed with subtypes of headache, the total number affected was high, supporting the need for further research into covariates and rarer types of headache.
  • There is a need to increase the capacity for treating veterans with headache as only 14% were treated in the VHA headache centers in the last fiscal year. 
  • 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 Deena Kuruvilla, MD, FAHS

Key messages

  • Headache is common amongst veterans in the Veterans Health Administration (VHA), with ‘headache not otherwise specified’ being the most common type, suggesting a need for physician headache diagnosis training.
  • Pain and psychiatric comorbidity is extremely high, indicating high patient complexity and a need for interdisciplinary headache treatment.
  • Although less than 1% of men and women were diagnosed with subtypes of headache, the total number affected was high, supporting the need for further research into covariates and rarer types of headache.
  • There is a need to increase the capacity for treating veterans with headache as only 14% were treated in the VHA headache centers in the last fiscal year. 

Background

What do we already know about this topic?

  • Little is known about veterans with headache despite the VHA being the largest integrated healthcare system in the United States.
  • National mandated traumatic brain injury screening within the VHA began in 2008.
  • The ability to evaluate men with headache across different types is rare, making the VHA headache sample unique.

How was this study conducted?

  • An evaluation of the Headache Centers of Excellence (HCoE) cohort of veterans, with at least one International Classifications of Diseases (ICD) 9 or 10 headache diagnosis code (n=1,442,650), over a 10-year period (2008–2018).
  • Logistic regressions evaluated gender differences in headache diagnosis, history of traumatic brain injury, post-traumatic stress disorder (PTSD) and non-headache pain conditions.

Findings

What does this study add?

  • ‘Headache not otherwise specified’ (76%) and migraine (36%) were the most frequently documented headache disorders.
  • Of the cohort, 3% had post-traumatic headache (PTH) and 5% traumatic brain injury.
  • In veterans with traumatic brain injury, the majority (85%) had ‘headache not otherwise specified’, almost half had migraine headaches, and PTSD was extremely high.
  • Men had significantly higher levels of traumatic brain injury, and PTSD with traumatic brain injury, than women.
  • Men had significantly lower migraine headaches with traumatic brain injury than women.
  • The rate of comorbidity was high, with limb and back pain being the most common painful conditions.
  • Psychiatric disorders were present in 15–35% of veterans overall and generally more prevalent in women than men.

Perspectives

How does this study impact clinical practice?

  • A high rate of comorbidity requires a holistic, interdisciplinary, approach to treatment in order to consider how best to treat symptoms of both conditions.
  • There is a pressing need for physician headache diagnosis training to lead to better treatment.

Perspectives

How does this study impact clinical practice?

  • A high rate of comorbidity requires a holistic, interdisciplinary, approach to treatment in order to consider how best to treat symptoms of both conditions.
  • There is a pressing need for physician headache diagnosis training to lead to better treatment.

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

Brenda Fenton, PhD, M.Sc
Associate Director, Headache Centers of Excellence Research & Evaluation Center
A Connecticut Healthcare System West Haven, Connecticut

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:

Deena Kuruvilla, MD, FAHS
Yale School of Medicine, New Haven, CT

Deena Kuruvilla, MD, FAHS
Yale School of Medicine, New Haven, CT

Dr. Deena Kuruvilla MD is a board-certified neurologist who is fellowship-trained in headache medicine. She is an assistant professor at the Yale School of Medicine. She is also certified in the subspecialty of Headache Medicine by the United Council for Neurologic Subspecialties and is a Fellow of the American Headache Society. Dr. Kuruvilla is a frequent moderator and speaker at national headache conferences, and her work has been featured in JAMACephalgia, and the Wall Street Journal. She is the former chair of the complementary and integrative medicine section and current chair of the women's health section of the American Headache Society.

Headache
Migraine

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