New research suggests that traumatic brain injury (TBI) alone may be a strong predictor for headaches in the first year of Veterans Affairs (VA) care among Iraq and Afghanistan war veterans. Additionally, the study’s findings reveal an association between comorbid psychiatric comorbidities and headaches among individuals with TBI.
Using data from the VA, the researchers reviewed patient data of Iraq and Afghanistan war veterans who received annual VA care from 2008 to 2011. Using ICD-9-CM codes to establish algorithms, investigators also identified comorbidities that could be associated with headache at the 2008 baseline examination, including TBI, posttraumatic stress disorder (PTSD), depression and conditions associated with a range of other diagnoses.
Among the 38426 cases examined, 13.7% of participants were diagnosed with headache in 2008, among whom were more likely than those without a headache diagnosis to also have a diagnosis of TBI alone (adjusted odds ratios [AOR] 6.75; 95% CI 5.79-7.86); TBI and depression (AOR 7.09; 95% CI 5.23-9.66), TBI and PTSD (AOR 10.16; 95% CI 8.96-11.53); TBI, PTSD, and depression (AOR 9.40; 95% CI 8.12-10.09); and neck pain (AOR 2.44; 95% CI 2.14-2.77).
Among those diagnosed with headache, 24.3% were found to have a headache diagnosis each subsequent year of care. Diagnoses of TBI, PTSD and/or depression at baseline were not associated with headache persistence. The researchers found that persistence was more likely for individuals with baseline tinnitus/hyperacusis (AOR 1.21; 95% CI 1.02-1.45), insomnia (AOR 1.19; 95% CI 1.02-1.39), and vertigo/dizziness (AOR 1.83; 95% CI 1.30-2.57).
“These results suggest that attention to other symptoms and conditions early in the diagnosis and treatment of headaches may be important for understanding prognosis,” the authors wrote. “These comorbidities offer potential targets for intervention strategies that may help address post-deployment headaches.”
Jaramillo CA, Eapen BC, McGeary CA, McGeary DD, Robinson J, Amuan M, et al. A cohort study examining headaches among veterans of Iraq and Afghanistan wars: Associations with traumatic brain injury, PTSD, and depression. Headache. 2016. doi: 10.1111/head.12726.