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Headache diagnoses among Iraq and Afghanistan war veterans enrolled in VA: a gender comparison.
Headache. 2013 Nov-Dec; 53(10):1573-82.H

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.

Authors+Show Affiliations

Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland VA Medical Center (R&D 66), Portland, OR; Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

24102376

Citation

Carlson, Kathleen F., et al. "Headache Diagnoses Among Iraq and Afghanistan War Veterans Enrolled in VA: a Gender Comparison." Headache, vol. 53, no. 10, 2013, pp. 1573-82.
Carlson KF, Taylor BC, Hagel EM, et al. Headache diagnoses among Iraq and Afghanistan war veterans enrolled in VA: a gender comparison. Headache. 2013;53(10):1573-82.
Carlson, K. F., Taylor, B. C., Hagel, E. M., Cutting, A., Kerns, R., & Sayer, N. A. (2013). Headache diagnoses among Iraq and Afghanistan war veterans enrolled in VA: a gender comparison. Headache, 53(10), 1573-82. https://doi.org/10.1111/head.12216
Carlson KF, et al. Headache Diagnoses Among Iraq and Afghanistan War Veterans Enrolled in VA: a Gender Comparison. Headache. 2013 Nov-Dec;53(10):1573-82. PubMed PMID: 24102376.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Headache diagnoses among Iraq and Afghanistan war veterans enrolled in VA: a gender comparison. AU - Carlson,Kathleen F, AU - Taylor,Brent C, AU - Hagel,Emily M, AU - Cutting,Andrea, AU - Kerns,Robert, AU - Sayer,Nina A, Y1 - 2013/09/19/ PY - 2013/08/04/accepted PY - 2013/10/10/entrez PY - 2013/10/10/pubmed PY - 2014/7/16/medline KW - Veteran KW - headache KW - health service use KW - women SP - 1573 EP - 82 JF - Headache JO - Headache VL - 53 IS - 10 N2 - 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. SN - 1526-4610 UR - https://www.unboundmedicine.com/medline/citation/24102376/Headache_diagnoses_among_Iraq_and_Afghanistan_war_veterans_enrolled_in_VA:_a_gender_comparison_ L2 - https://doi.org/10.1111/head.12216 DB - PRIME DP - Unbound Medicine ER -