title: Headaches during war: analysis of presentation, treatment, and factors associated with outcome.
abstract: BACKGROUND
  Headache is often associated with physical trauma and psychological stress. The aim of this study is to evaluate the impact of headache on personnel deployed in war zones and to identify factors associated with return to duty (RTD).
  
  
  METHODS
  Outcome data were prospectively collected on 985 personnel medically evacuated out of Operations Iraqi and Enduring Freedom for a primary diagnosis of headache between 2004 and 2009. Electronic medical records were reviewed to examine clinical and treatment patterns and the effect that myriad factors had on RTD.
  
  
  RESULTS
  33.6% of evacuees returned to duty. The most common headaches were post-concussion (34.1%) and migraine (30.0%). Headaches typically associated with trauma such as post-concussion (18.7%), occipital neuralgia (23.1%), and cervicogenic headache (29.7%) had the lowest RTD rates, whereas tension headache (49.6%) was associated with the best outcome. Other variables associated with negative outcome included presence of aura (OR 0.51, 95% CI 0.30-0.88; p = 0.02), traumatic brain injury (OR 0.50, 95% CI 0.29-0.87; p = 0.01), opioid (OR 0.41, 95% CI 0.26-0.63; p < 0.001), and beta-blocker (OR 0.26, 95% CI 0.12-0.61; p = 0.002) use, and co-existing psychopathology (p < 0.001 in univariable analysis).
  
  
  CONCLUSIONS
  Headaches represent a significant cause of unit attrition in personnel deployed in military operations, with physical trauma and co-existing psychopathology associated with poorer outcomes.
authors: Johns Hopkins School of Medicine, Baltimore, MD 21029, USA. scohen40@jhmi.edu
authors: Steven P
authors: SP
authors: Cohen
authors: Anthony R
authors: AR
authors: Plunkett
authors: Indy
authors: I
authors: Wilkinson
authors: Conner
authors: C
authors: Nguyen
authors: Connie
authors: C
authors: Kurihara
authors: Artemus
authors: A
authors: Flagg
authors: Benny
authors: B
authors: Morlando
authors: Christina
authors: C
authors: Stone
authors: Ronald L
authors: RL
authors: White
authors: Victoria C
authors: VC
authors: Anderson-Barnes
authors: Samuel M
authors: SM
authors: Galvagno
mesh_terms: D000328:Adult; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D020773:Headache Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D014187:Transportation of Patients / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult