A cohort study examining headaches among veterans of Iraq and Afghanistan wars: Associations with traumatic brain injury, PTSD, and depression
A cohort study examining headaches among veterans of Iraq and Afghanistan wars: Associations with traumatic brain injury, PTSD, and depression
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DOI：
10.1111/head.12726
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发表时间：
2016-03-01
期刊：
影响因子：
5
通讯作者：
Pugh, Mary Jo
中科院分区：
文献类型：
--
作者：
Jaramillo, Carlos A.;Eapen, Blessen C.;Pugh, Mary Jo
目的描述美国退伍军人在伊拉克和阿富汗战争中头痛及相关疾病的患病率和持续性。背景伊拉克和阿富汗战争退伍军人(IAV)患有持续性和难以治疗的头痛，这些头痛被发现与创伤性脑损伤(TBI)和其他与部署相关的并发症并存。方法这项纵向队列研究使用了来自美国退伍军人健康管理局(VA)数据库的数据，这些人在2008年首次接受VA治疗(基线)，并在2009、2010和2011年每年接受治疗。我们使用ICD-9-CM代码来识别每年(2008-2011年)接受头痛治疗的人。每年被诊断为头痛的人被归类为持续性头痛。我们还使用经ICD-9-CM编码验证的算法确定了可能与基线头痛相关的合并症。并发症包括脑外伤、创伤后应激障碍(PTSD)、抑郁，以及与这些诊断相关的情况(焦虑、记忆/注意力/认知、颈部疼痛、耳鸣/听觉过敏、光敏/光模糊、失眠、不适/疲劳和眩晕/头晕)。结果在所有IAV中，38,426人在2008年接受了VA护理的第一年，并在2009-2011年间每年接受护理：其中13.7%的人在2008年被诊断为头痛。2008年被诊断为头痛的退伍军人比那些没有头痛诊断的退伍军人更有可能同时被诊断为脑外伤(调整后的优势比[AOR]6.75；95%CI 5.79-7.86)、脑外伤+抑郁(AOR 7.09；95%CI 5.23-9.66)、脑损伤+创伤后应激障碍(AOR 10.16；95%CI 8.96-11.53)、脑外伤+PTSD+抑郁(AOR 9.40；95%CI 8.12-10.09)以及颈部疼痛(AOR 2.44；95%CI 2.14-2.77)。在2008年被诊断为头痛的患者中，24.3%的患者在接下来的几年中每年都被诊断为头痛(持续性头痛)。虽然基线时诊断出的脑损伤、创伤后应激障碍和/或抑郁与头痛的持续性无关，但基线耳鸣/听力亢进(AOR 1.21；95%CI 1.02-1.45)、失眠(AOR 1.19；95%CI 1.02-1.39)和眩晕/头晕(AOR 1.83；95%CI 1.30-2.57)的个体更有可能持续头痛。结论我们的结果表明，在IAV接受VA护理的第一年，TBI是头痛的强大预测因子，合并精神疾病增加了患有TBI的个体发生头痛的可能性。然而，在有基线头痛的患者中，只有耳鸣、失眠和眩晕是头痛持续性的基线临床预测因素。这些结果表明，在头痛的早期诊断和治疗中注意其他症状和情况可能对了解预后很重要。这些并存为干预战略提供了潜在的目标，可能有助于解决部署后的头痛问题。
ObjectivesTo describe the prevalence and persistence of headache and associated conditions in an inception cohort of U.S. veterans of Iraq and Afghanistan wars.BackgroundIraq and Afghanistan war veterans (IAV) suffer from persistent and difficult-to-treat headaches that have been found to co-occur with traumatic brain injury (TBI) and other deployment related comorbidities.MethodsThis longitudinal retrospective cohort study used data from the national Veterans Health Administration (VA) data repository for IAV who first received VA care in 2008 (baseline) and also received care each year in 2009, 2010, and 2011. We used ICD-9-CM codes, to identify those treated for headache each year (2008-2011). Individuals with headache diagnosed each year were classified as having persistent headache. We also identified comorbidities that may be associated with baseline headache using algorithms validated for use with ICD-9-CM codes. Comorbidities included TBI, posttraumatic stress disorder (PTSD), depression, and conditions associated with these diagnoses (anxiety, memory/attention/cognition, neck pain, tinnitus/hyperacusis, photosensitivity/photo blurring, insomnia, malaise/fatigue, and vertigo/dizziness). Multivariable logistic regression analysis was used to determine characteristics associated with baseline headache as well as those associated with persistent headache.ResultsAmong all IAV, 38,426 received their first year of VA care in 2008 and had care each year 2009-2011: 13.7% of these were diagnosed with headache in 2008. Veterans diagnosed with headache in 2008 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+depression (AOR 7.09; 95% CI 5.23-9.66), TBI+PTSD (AOR 10.16; 95% CI 8.96-11.53), TBI+PTSD+depression (AOR 9.40; 95% CI 8.12-10.09), and neck pain (AOR 2.44; 95% CI 2.14-2.77). Among those with headache diagnosis in 2008, 24.3% had a headache diagnosis each of the subsequent years of care (persistent headache). While diagnoses of TBI, PTSD, and/or depression at baseline were not associated with headache persistence, 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).ConclusionsOur results indicate that TBI alone is a strong predictor of headache in the first year of VA care among IAV and that comorbid psychiatric comorbidities increase the likelihood of headache among individuals with TBI. However, among those with baseline headache, only tinnitus, insomnia, and vertigo were baseline clinical predictors of headache persistence. These results suggest that attention to other symptoms and conditions early in the diagnosis and treatment of headaches may be important for understanding prognosis. These comorbidities offer potential targets for intervention strategies that may help address postdeployment headaches.