Over 1.5 million US vets diagnosed with headache: improved outreach, care needed
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CHICAGO — With more than 1.5 million veterans diagnosed with headache over the past two decades, the Veterans Health Administration must improve outreach and care to address disparities, an expert said at ANA 2022.
“Every time we see someone with headache disease, if it’s migraine, cluster headache — we need to remember — they’re people,” Jason J. Sico, MD, MHS, national director of the Headache Centers of Excellence program at the U.S. Department of Veterans Affairs and associate professor of neurology and internal medicine at Yale School of Medicine, said during a presentation. “We can take that information ... and feed it back to policy people, administrators, clinicians, to understand how we could make this process better.”
According to Sico, 1,524,960 U.S. military veterans (1,262,455 men; 262,505 women) were diagnosed with at least one headache condition between October 2018 and September 2019, prompting 8.2 million unique visits to the VA where care for headache was provided.
Further, male veterans were often older than their female counterparts (mean age, 52 years vs. 42 years) and more likely to be married. They also were almost twice as likely to have a traumatic brain injury (2.9% vs. 1.1%) and concurrent PTSD (23.7% vs. 21.7%) compared with female veterans.
Conversely, female veterans were more than 11 times more likely to experience military sexual abuse trauma than their male counterparts (33.7% vs. 3.2%), and were almost twice as likely to have migraines compared with men (60.1% vs. 32.4%), both with and without aura, he said.
Regarding headache care, both male and female veterans utilized primary care most often (71.9% vs. 69.5%), with just 27.4% of women and 20.8% of men seeking care from a neurologist and significantly fewer seeking care from a pain clinic or psychiatrist.
To address these issues and provide better care for all military personnel, Sico suggested several options — educational and training initiatives to improve diagnostic specificity; expansion of the VA Headache Centers of Excellence program; geomapping veterans with headache disease and care quality within a clinical setting; and conducting detailed analyses in connection with suicide, associations between military exposures and headache disease and opioid use.
“We’ve been using this information to implement care quality interventions, educating about diagnostic criteria,” Sico stated. “We have so much work to do to look at additional disparities in care.”