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Abstract Details

Survivors of Military Sexual Trauma face increased risk of Migraine Headaches and Worse Headache Care
Headache Posters (7:00 AM-5:00 PM)
MST is increasingly recognized in US Veterans. MST is associated with psychiatric, substance abuse, and pain conditions, including headache.  

To determine the association of military sexual trauma (MST) with migraine and headache care.

We analyzed administrative data from the Women’s Veteran’s Cohort Study, a sample of post-9/11 US Veterans enrolled for Veterans Health Administration (VHA) care. A positive MST screen defined exposure. We extracted demographic and clinical data from administrative coding for migraine and relevant confounders, comparing subgroups with Chi-square analysis. Healthcare utilization variables designated sites of care and prescribed abortive and preventative treatments and were evaluated with multivariable logit, negative binomial (nb), and zero-inflated nb models .

Of 846,435 Veterans, 37,375 (66% female, 34% male) had a positive screen, while 80,696 had migraine.  Veterans with migraines and MST (21.7% of MST(+)) were more often non-white (45.3% vs. 38.6%, p<0.001), and ≤33 years old (55% vs. 53%, p<0.001) than Veterans with migraine alone (9% of MST(-)).  Adjusting for gender, the odds of migraine were substantially greater for MST(+) (OR 1.62, 95% CI 1.57,1.67.)    

MST(+) Veterans were more likely to receive headache abortive and preventative medications discordant with AAN/AHS guidelines (OR 1.29,95% CI 1.21, 1.36; OR 1.70,95% CI 1.60,1.81 respectively), especially opioids (OR 1.26,95% CI 1.19, 1.33) after adjustment for gender and comorbid conditions.  Healthcare utilization was increased among MST(+) migraine Veterans  for primary care (IRR 1.06, 95% CI 1.04, 1.08, p<0.001), and emergency room care (IRR 1.14, (95% CI 1.07, 1.22) , while neurology visits were not increased (IRR 0.97, 95% CI 0.92, 1.02) among MST(+) patients with migraine controlling for gender, comorbidities, treatments,  and other healthcare use.

Veterans with MST constitute a vulnerable population and are more likely to have migraine, receive more emergency care, and take pharmacotherapies discordant with recommended guidelines for migraine.
John Ney, MD, MPH, FAAN (VA Connecticut )
Dr. Ney has received personal compensation for serving as an employee of Surgican Neuromonitoring Associates, PLLC. Dr. Ney has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Ceribell. Dr. Ney has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology Clinical Practice.
Brenda Fenton Brenda Fenton has nothing to disclose.
Amy Grinberg, PhD The institution of Amy Grinberg has received research support from Department of Veteran Affairs.
Kathryn Min (VA CT) Kathryn Min has nothing to disclose.
Manali Phadke (Yale University) Manali Phadke has nothing to disclose.
Cynthia A Brandt, 3859 The institution of Cynthia A Brandt, 3859 has received research support from Department of Veterans affairs.
Sally Haskell No disclosure on file
Jason J. Sico, MD, FAAN Dr. Sico has nothing to disclose.