Johns Hopkins School of Medicine, Baltimore, MD 21029, USA.
Cephalalgia. 2012 Jan;32(2):94-108. doi: 10.1177/0333102411422382. Epub 2011 Oct 12.
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).
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.
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).
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.
头痛常与身体创伤和心理压力有关。本研究旨在评估战区部署人员头痛对其返回工作岗位（RTD）的影响，并确定与 RTD 相关的因素。
前瞻性收集了 2004 年至 2009 年间因头痛这一主要诊断而从伊拉克和持久自由行动中医疗后送的 985 名人员的结果数据。审查电子病历以检查临床和治疗模式以及众多因素对 RTD 的影响。
33.6%的后送人员返回工作岗位。最常见的头痛是脑震荡后头痛（34.1%）和偏头痛（30.0%）。与创伤相关的头痛，如脑震荡后头痛（18.7%）、枕神经痛（23.1%）和颈源性头痛（29.7%）的 RTD 率最低，而紧张性头痛（49.6%）的结果最好。其他与不良结局相关的变量包括先兆（OR 0.51，95%CI 0.30-0.88；p=0.02）、创伤性脑损伤（OR 0.50，95%CI 0.29-0.87；p=0.01）、阿片类药物（OR 0.41，95%CI 0.26-0.63；p<0.001）和β受体阻滞剂（OR 0.26，95%CI 0.12-0.61；p=0.002）的使用以及并存的精神病理学（在单变量分析中 p<0.001）。
头痛是军事行动部署人员单位减员的一个重要原因，身体创伤和并存的精神病理学与较差的结果相关。
