Headaches More Prevalent After 9/11, Associated With Anxiety

Allison Gandey

June 30, 2010

June 30, 2010 (Los Angeles, California) — A new study looking at patients enrolled at the Bellevue Hospital World Trade Environmental Health Center finds that many have begun suffering from new headache since the collapse of the World Trade Center towers in September 2001. Findings suggest these new symptoms are often related to anxiety, depression, and posttraumatic stress disorder.

"We found that 44% of patients reported new persistent headache after 9/11," said presenter Katherine Henry, MD, from the New York University School of Medicine, in New York City.

Dr. Katherine Henry

The results were released here at the American Headache Society 52nd Annual Scientific Meeting.

In a surprising twist, the researchers found that exposure to the initial trade center dust cloud, reported by almost 55% of this group, was a nonsignificant variable in 3 separate analyses. What emerged instead were mental health factors.

"These comorbidities are not that different from other patients," Dr. Henry told Medscape Neurology. "Anxiety, depression, and posttraumatic stress are common, but they should especially be taken into consideration when treating patients involved in this disaster."

Dr. Henry said treatment is generally not more difficult. "Most patients will respond to appropriate headache therapy. Mental health comorbidities will have to be taken into account, and some patients will require psychiatric care."

Structured Questionnaires

Investigators studied 646 patients enrolled in the Bellevue Hospital World Trade Environmental Health Center between January 2008 and March 2009. Participants responded to structured questionnaires. Researchers assessed anxiety and depression using the Hopkins Anxiety and Depression Scales. They evaluated posttraumatic symptoms using a posttraumatic stress disorder checklist.

New Headache After 9/11 and Mental Health Symptoms

Symptom All Participants, n = 646 (%) New Headache (%) No Headache After 9/11 (%) P Value
Anxiety
No 51 33 65 <.0001
Yes 49 67 35
Depression
No 46 32 56 <.0001
Yes 55 68 44
Probable posttraumatic stress disorder
No 60 47 69 <.0001
Yes 40 53 31

Logistic Regression of Mental Health Variables Linked to Headache

Variable Odds Ratio 95% Confidence Interval P Value
Anxiety 2.19 1.49 - 3.22 <.0001
Depression 1.75 1.20 - 2.56 =.003
Probable posttraumatic stress disorder 1.60 1.09 - 2.36 =.016

Dr. Henry and her team also reported other significant variables after 9/11 associated with new-onset headache, including dyspnea with exercise, gastroesophageal reflux, nasal drip, and sinus congestion. After adjustment, new-onset headache was also associated with younger age and lower income and education.

Headache and Comorbidities

Vijaya Patil, MD, from the Edward Hines Junior Veterans Affairs Hospital in Illinois, said she is not surprised by the findings related to anxiety, depression, and posttraumatic stress disorder. "In our work, we also found an increased prevalence of psychiatric and also sleep disorders."

Dr. Patil presented a poster at the meeting showing an increased prevalence of headache in veterans with mild traumatic brain injury. "The VA is well equipped to service patients with multiple comorbidities all in one place and help patients avoid multiple visits. This will be more difficult in the civilian population."

John Claude Krusz, MD, from the Anodyne Headache and Pain Care in Dallas, Texas, said he agrees that paying close attention to comorbidities is key.

Dr. Krusz was also a poster presenter at the meeting, and he echoed Dr. Patil's concern about monitoring sleep. "Too many people focus on just 1 thing, and the reality is that patients are a layer cake of lots of different elements," he said. "We need to look at the broader picture."

This study was funded by the National Institutes of Health. The researchers have disclosed no relevant financial relationships.

American Headache Society 52nd Annual Scientific Meeting: Poster 4. Presented June 26, 2010.

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