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. 2024 Sep 3;7(9):e2431522.
doi: 10.1001/jamanetworkopen.2024.31522.

Open Burn Pit Exposure in Headache Disorder and Migraine

Jason J Sico  1   2   3   4 , Sarah E Anthony  1   2 , Manali Phadke  1   5 , Kaicheng Wang  1   5 , Melissa Skanderson  3 , John P Ney  1   6 , Elizabeth K Seng  3   7   8   9 , Robert E Shapiro  10 , Friedhelm Sandbrink  11 , Joel D Scholten  12 , Glenn D Graham  13   14 , Sharyl R Martini  13   15 , Brenda T Fenton  1   16
Affiliations

Open Burn Pit Exposure in Headache Disorder and Migraine

Jason J Sico et al. JAMA Netw Open. .

Abstract

Importance: Open burn pits have commonly been used for waste disposal by the US military but have not been systematically investigated as an independent risk factor for headache disorders.

Objective: To evaluate the association between exposure to open burn pits and incidence of headache and migraine.

Design, setting, and participants: This retrospective cohort study used data from the Veterans Health Administration Headache Cohort along with data from the US Department of Defense and the Airborne Hazards and Open Burn Pit (AH&OBP) Registry to assess registry participants with potential exposure to open burn pits in the Veterans Health Administration from April 1, 2014, through October 31, 2022. Participants were included by linking data from the AH&OBP Registry to their US Department of Defense and Veterans Health Administration electronic health records. Those with preexisting headache were removed from the analytic sample. The analysis was conducted between November 1, 2022, and January 31, 2024.

Exposure: Open burn pit exposure composite variables based on the registry questionnaire were examined, specifically being near open burn pits, days near open burn pits, and having open burn pit duties.

Main outcomes and measures: Primary incident outcomes included medically diagnosed headache disorders and medically diagnosed migraine.

Results: The analytic sample included 247 583 veterans (mean [SD] age, 27.9 [7.7] years; 222 498 [89.9%] male). After covariates were controlled for at baseline, participants who were near an open burn pit with open burn pit duties had the highest adjusted odds of medically diagnosed headache disorders (adjusted odds ratio [AOR], 1.59; 95% CI, 1.46-1.74), migraine (AOR, 1.60; 95% CI, 1.43-1.79), and self-reported disabling migraine (AOR, 1.93; 95% CI, 1.69-2.20) compared with those without exposure. The 2 highest quartiles of cumulative burn pit exposure (290-448 days and >448 days) had significantly higher adjusted odds of medically diagnosed headache (290-448 days: AOR, 1.20; 95% CI, 1.09-1.31; >448 days: AOR, 1.55; 95% CI, 1.41-1.70) and migraine (290-448 days: AOR, 1.19; 95% CI, 1.07-1.34; >448 days: AOR, 1.48; 95% CI, 1.32-1.65).

Conclusions and relevance: In this cohort study, a dose-dependent association existed between open burn pit exposure and medically diagnosed headache and migraine. These new data identify potentially important associations between open burn bit exposure and new-onset headache among service personnel as well as a possible health condition that may be encountered more frequently in Veterans Health Administration facilities during mandatory screening for military exposures.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Seng reported receiving grants from the Veterans Health Administration during the conduct of the study and personal fees from GlaxoSmithKline, AbbVie, Theranica, and Click Therapeutics outside the submitted work. Dr Shapiro reported receiving personal fees from Eli Lilly and nonfinancial support from Eli Lilly, Lundbeck, Theranica, and AbbVie outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of Airborne Hazards and Open Burn Pit (AH&OBP) Registry Participants in the Analytic Sample (April 1, 2014, to October 31, 2022)
DaVINCI indicates US Department of Defense and US Department of Veterans Affairs Informatics and Computing Infrastructure; SSN, Social Security number; VA, Department of Veterans Affairs; VA CDW, VA Corporate Data Warehouse.
Figure 2.
Figure 2.. Adjusted Odds Ratios (AORs) for Medically Diagnosed Headache and Migraine by Amount of Open Burn Pit Exposure Compared With No Burn Pit Exposure
Diagnoses of medically diagnosed headache and migraine were assigned by medical practitioners accordingly in clinical encounters (International Classification of Diseases, Ninth Revision, Clinical Modification and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnostic codes). No open burn pit exposure was the reference group for panels A and C, and 0 days of cumulative exposure served as the reference group for panels B and D. Odds ratios were adjusted for age, sex, race and ethnicity, branch of service, and presence of traumatic brain injury. Error bars indicate 95% CIs.
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