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BACKGROUND/RATIONALE:
Chronic Headache among OEF/OIF Veterans Exposed to Blasts
Chronic headaches conditions are common in the population of veterans receiving care in the VA health care system. Among veterans of the Persian Gulf War, headaches are one of the most frequently reported complaints, and veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) who have not suffered traumatic combat-related injuries appear to experience similar post-deployment difficulties. Unfortunately, there is reason to believe that OEF/OIF veterans who have been exposed to blasts are more likely to experience disabling headache conditions. Civilian sector data indicate that rates of persistent Chronic Post-Traumatic Headache (CPTH) range between 18-33% following traumatic brain injury. Among blast injury patients treated at the James A. Haley Veterans Hospital Polytrauma Rehabilitation Center, the rate of headache complaints was found to be approximately 55%. Given the increasing likelihood of exposure to blasts among OEF/OIF personnel as the conflict endures, it is expected that disabling primary and secondary headaches will pose a significant challenge to the Veterans Healthcare Administration in the coming decades. The development and dissemination of effective early intervention approaches may prevent or attenuate the long-term individual and societal impact of these conditions.
OBJECTIVE(S):
The purpose of the current study is to provide an initial evaluation of the clinical characteristics and treatment of headache conditions among OEF/OIF veterans who have been exposed to blast during deployment. Because blast-related headaches are not represented in the current CPTH literature, it is not know to what extent these conditions conform to the existing classification schemes or how they will respond to available treatment options. The proposed pilot project will address these clinical questions through a comprehensive patient assessment and the delivery of a modified version of a cognitive-behavioral headache intervention, a "best practice" for those with chronic, disabling headaches. It is expected that these data will allow us to contribute to improved diagnostic practices through better description of the features of blast-related headache (QUERI Step 1), to facilitate identification of risk factors for the development of disabling headache conditions (QUERI Step 1), and to assess the feasibility and potential effectiveness of the application of a "best practice" in this new and growing population (QUERI Step 2).
METHODS:
This six-month pilot project will recruit participants from all OEF/OIF
veterans referred to the JAHVH PRC Blast Injury Clinic. Criteria for participation in the study include; 1) the ability to read and comprehend written and spoken English, 2) no current severe psychiatric or substance abuse disorder, 3) medical clearance, 3) a history of blast exposure, 4) no greater than moderate traumatic brain injury, and 5) a current headache condition of at least three months duration. Women and minorities will be included to the extent that they are represented in the population. Based on current referral patterns, it is expected that a pool of approximately 4 to 9 eligible individuals will be available each week. Past experience with this population suggests that participation rates will be as high as 70%, providing a sample of up to 120 participants for the 6-month study duration. For those who agree to participate, the attending physician will perform a comprehensive physical exam and headache assessment and a pain psychologist will conduct a clinical interview and administer a battery of self-report measures during their first visit. Due to time and budgetary restrictions, a case-series design will be utilized for the evaluation of the feasibility and effectiveness of the BCBHMT. All participants will be scheduled for a second visit during which the intervention will be delivered. Participants will be contacted via telephone three months following completion of the BCBHMT in order to assess primary and secondary endpoints, compliance, program component preferences and barriers, and treatment satisfaction. The primary endpoint will be the change in number of headache free days from the 4-week period prior to treatment to the 4-week period prior to the 3-month phone follow-up. Secondary analyses will evaluate changes in headache severity and duration, functional disability, and health-related quality of life. The decision regarding which data analytic procedures to use will be based on an evaluation of the resulting distributions of each variable. When appropriate, standard parametric ANOVA and regression procedures will be used.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
Standard headache screening practices are being implemented in the James A. Haley Veterans Hospital Blast Injury Clinic.
PUBLICATIONS:
None at this time.
DRA:
Acute and Traumatic Injury, Military and Environmental Exposures
DRE:
Rehabilitation, Treatment
Keywords:
Operation Enduring Freedom, Operation Iraqi Freedom, Traumatic Brain Injury
MeSH Terms:
none
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