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Headache Diagnoses Among Iraq and Afghanistan War Veterans Enrolled in VA: A Gender Comparison

Authors

  • Kathleen F. Carlson PhD,

    Corresponding author
    1. Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland VA Medical Center (R&D 66), Portland, OR
    2. Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR
    • Address all correspondence to K.F. Carlson, Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland VA Medical Center (R&D 66), 3715 SW U.S. Veterans Hospital Road, Portland, OR 97239, USA, email: kathleen.carlson@va.gov

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  • Brent C. Taylor PhD,

    1. Minneapolis VA Healthcare System (152/2E), Center for Chronic Disease Outcomes Research, Minneapolis, MN
    2. Department of Medicine, University of Minnesota Medical School, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
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  • Emily M. Hagel MS,

    1. Minneapolis VA Healthcare System (152/2E), Center for Chronic Disease Outcomes Research, Minneapolis, MN
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  • Andrea Cutting MA,

    1. Minneapolis VA Healthcare System (152/2E), Center for Chronic Disease Outcomes Research, Minneapolis, MN
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  • Robert Kerns PhD,

    1. Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System (11ACSLG), West Haven, CT
    2. Departments of Psychiatry, Neurology and Psychology, Yale University, West Haven, CT
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  • Nina A. Sayer PhD

    1. Minneapolis VA Healthcare System (152/2E), Center for Chronic Disease Outcomes Research, Minneapolis, MN
    2. Departments of Medicine, Psychiatry, and Psychology, University of Minnesota Medical School, Minneapolis, MN
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  • Conflict of Interest: The authors have no financial disclosures or conflicts of interest to report.

Abstract

Objective

To examine the prevalence and correlates of headache diagnoses, by gender, among Iraq and Afghanistan War Veterans who use Department of Veterans Affairs (VA) health care.

Background

Understanding the health care needs of recent Veterans, and how these needs differ between women and men, is a priority for the VA. The potential for a large burden of headache disorders among Veterans seeking VA services exists but has not been examined in a representative sample.

Methods

We conducted a historical cohort study using national VA inpatient and outpatient data from fiscal year 2011. Participants were all (n = 470,215) Iraq and Afghanistan War Veteran VA users in 2011; nearly 13% were women. We identified headache diagnoses using International Classification of Diseases (ICD-9) diagnosis codes assigned during one or more VA inpatient or outpatient encounters. Descriptive analyses included frequencies of patient characteristics, prevalence and types of headache diagnoses, and prevalence of comorbid diagnoses. Prevalence ratios (PR) with 95% confidence intervals (CI) were used to estimate associations between gender and headache diagnoses. Multivariate models adjusted for age and race. Additional models also adjusted for comorbid diagnoses.

Results

In 2011, 56,300 (11.9%) Veterans received a headache-related diagnosis. While controlling for age and race, headache diagnoses were 1.61 times more prevalent (95% CI = 1.58-1.64) among women (18%) than men (11%). Most of this difference was associated with migraine diagnoses, which were 2.66 times more prevalent (95% CI = 2.59-2.73) among women. Cluster and post-traumatic headache diagnoses were less prevalent in women than in men. These patterns remained the same when also controlling for comorbid diagnoses, which were common among both women and men with headache diagnoses. The most prevalent comorbid diagnoses examined were depression (46% of women with headache diagnoses vs 40% of men), post-traumatic stress disorder (38% vs 58%), and back pain (38% vs 46%).

Conclusions

Results of this study have implications for the delivery of post-deployment health services to Iraq and Afghanistan War Veterans. Migraine and other headache diagnoses are common among Veterans, particularly women, and tend to occur in combination with other post-deployment health conditions for which patients are being treated.

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