Gender differences related to headache diagnosis exist among veterans in the United States with women more likely to receive the diagnoses of migraine or tension-type headaches, while men were more often diagnosed with headaches related to trauma or cluster headaches, according to findings published in Neurology.
Researchers conducted a retrospective cohort study to assess gender differences in headache diagnoses among American veterans receiving care for headaches between 2008 and 2019 through the Veterans Health Administration (VHA). They identified 1,562,036 veterans who received at least 1 outpatient or inpatient visit related to a headache diagnosis during this period.
Using the electronic health record (EHR) data by the VHA, the researchers obtained ICD-9 and ICD-10 codes to select and classify headache diagnoses into 8 categories, including:
- tension-type headache
- trigeminal autonomic cephalalgias
- headache, not-otherwise-specified (NOS)
- posttraumatic headache
- post-whiplash headache
- other primary headache disorders, and
- other secondary headache disorders.
The researchers found that compared with women, men were often White (70.4% vs 56.7%), older (52.0±16.8 vs 41.9±13.0 years), and had higher rates of traumatic brain injury (TBI; 2.9% vs 1.1%) and posttraumatic stress disorder (PTSD; 23.7% vs 21.7%). However, men had lower rates of military sexual trauma (3.2% vs 33.7%; P <.001, for all)
They also observed that men more often than women obtained diagnoses of post-traumatic headache (3.4% vs. 1.9%; P <.001), post-whiplash headache (5.5% vs. 5.1%; P <.001), cluster headache (1.7% vs 0.9%), and headache, NOS (77.4% vs. 67.7%; P <.001).
Men demonstrated fewer headache types diagnosed (mean, 1.3 vs. 1.5; P <.001), often only having 1 type of headache diagnosed compared with women (75.0% vs. 61.6%, respectively). Compared with women, men showed decreased number of encounters for headaches per year (0.8 vs 1.2; P <.001) and less number of visits to specialists for headaches (20.8% vs. 27.4%; P <.001) compared with women.
In contrast, women were more likely to receive care at the emergency department for headaches than men (22.9% vs. 20.3%; P <.001). Women more frequently received the diagnosis of migraine (60.1% vs. 32.4%), tension-type headache (8.2% vs. 7.0%), other primary headache (3.2% vs. 2.9%), and other secondary headache (1.3% vs. 1.0%).
“Important gender differences exist for men and women Veterans receiving headache care within VHA regarding sociodemographic characteristics, headache diagnoses, military exposure, and headache healthcare utilization,” the researchers stated. “The findings have potential implications for providers and the healthcare system caring for Veterans living with headache.”
Study limitations included lack of generalizability outside of the predominantly male veteran population, differentiation of headaches inclusive of transgender and non-binary gender categories, examination of headache types based upon branch of the military the veteran served, possible headache misdiagnosis, and undercoding of specific headache diagnoses. Additionally, the researchers did not assess the impact of headache treatments and physical and mental health comorbidities on headache diagnosis or frequency of utilization of healthcare services.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Sico JJ, Seng E, Wang K, et al. Characteristics and gender differences of headache in the Veterans Health Administration: a national cohort study, fiscal year 2008-2019. Neurology. Published online September 13, 2022. doi:10.1212/WNL.0000000000200905