Conflict of Interest: Simon Wessely is Honorary Civilian Consultant Advisor in psychiatry to the British Army and a Trustee of Combat Stress, a UK charity that provides services and support for veterans with mental health problems. No conflict of interest for other authors.
Risk Factors for Headache in the UK Military: Cross-Sectional and Longitudinal Analyses
Article first published online: 10 APR 2013
© 2013 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 53, Issue 5, pages 787–798, May 2013
How to Cite
Rona, R. J., Jones, M., Goodwin, L., Hull, L. and Wessely, S. (2013), Risk Factors for Headache in the UK Military: Cross-Sectional and Longitudinal Analyses. Headache: The Journal of Head and Face Pain, 53: 787–798. doi: 10.1111/head.12101
Funding: This study was funded by the UK Ministry of Defence (MoD).
- Issue published online: 24 APR 2013
- Article first published online: 10 APR 2013
- Manuscript Accepted: 24 FEB 2013
- UK Ministry of Defence (MoD)
- cohort study;
- functional impairment;
- psychological distress;
- post-traumatic stress disorder;
- traumatic brain injury
To assess the importance of service demographic, mental disorders, and deployment factors on headache severity and prevalence, and to assess the impact of headache on functional impairment.
There is no information on prevalence and risk factors of headache in the UK military. Recent US reports suggest that deployment, especially a combat role, is associated with headache. Such an association may have serious consequences on personnel during deployment.
A survey was carried out between 2004 and 2006 (phase 1) and again between 2007 and 2009 (phase 2) of randomly selected UK military personnel to study the health consequences of the Iraq and Afghanistan wars. This study is based on those who participated in phase 2 and includes cross-sectional and longitudinal analyses. Headache severity in the last month and functional impairment at phase 2 were the main outcomes.
Forty-six percent complained of headache in phase 2, half of whom endorsed moderate or severe headache. Severe headache was strongly associated with probable post-traumatic stress disorder (multinomial odds ratio [MOR] 9.6, 95% confidence interval [CI] 6.4-14.2), psychological distress (MOR 6.15, 95% CI 4.8-7.9), multiple physical symptoms (MOR 18.2, 95% CI 13.4-24.6) and self-reported mild traumatic brain injury (MOR 3.5, 95% CI 1.4-8.6) after adjustment for service demographic factors. Mild headache was also associated with these variables but at a lower level. Moderate and severe headache were associated with functional impairment, but the association was partially explained by mental disorders. Mental ill health was also associated with reporting moderate and severe headache at both phase 1 and phase 2. Deployment and a combat role were not associated with headache.
Moderate and severe headache are common in the military and have an impact on functional impairment. They are more strongly associated with mental disorders than with mild traumatic brain injury.