Veteran deployed burn pits exposure: headache phenotypes, trajectories, and outcomes: a mixed-methods evaluation
Cassandra Laferriere1,2, Daniel G Rogers1,2, Nicholas A Rattray1,3,4,5
1Headache Centers of Excellence, Veterans Affairs, VA Connecticut Healthcare System, West Haven, CT, United States.
Background:
Exposure to open burn pit smoke and fumes during military service has been associated with a range of chronic health conditions. Little is known about the specific phenotypical manifestations of open burn pit-related headaches and their health impacts.
Aims:
The study aimed to: 1. classify headache phenotypes and evaluate associated health outcomes among Veterans with self-reported open burn pit exposure and headache; 2. use a mixed-methods approach to characterize broader health impacts by exposure level and headache phenotype; and 3. identify healthcare trajectories of Veterans exposed to burn pits during and after deployment, including satisfaction with headache care within the Veterans Health Administration (VHA).
Methods:
We analyzed a sample of 247,583 participants with linked self-reported open burn pit exposure and International Classification of Diseases (ICD)-coded health data from the Airborne Hazards and Open Burn Pit (AH&OBP) Registry, Department of Defense (DoD), and VHA Electronic Health Records (EHRs). A randomly selected subset of 1,980 participants received an online) survey assessing sociodemographic information, burn pit exposure, headache symptoms and outcomes, care seeking, social determinants of health (SDOH), and acceptability of care. Respondents were invited to participate in semi-structured interviews.
Results:
Among the 772 Veterans who responded (39.0%), 335 (43.4%) completed all headache phenotyping items. We conducted interviews with 49 Veterans. Quantitative findings showed significant differences across headache phenotypes in headache-related disability and insomnia. Veterans with migraine and post-traumatic headache (PTH) reported greater impairment than those with "other headache", suggesting higher overall disease burden relative to other headache types. Additionally, 68.0% of Veterans who completed SDOH items reported social isolation. Qualitative findings further contextualized symptom burden within Veterans lived experiences. Many described onset of headache symptoms during deployment and inconsistent access to guideline-concordant headache care. Post-deployment trajectories varied widely, particularly in coordination, continuity, and access to stepped headache care (SHC).
Conclusions:
Veterans exposed to open burn pits exhibited heterogenous post-deployment healthcare trajectories and high disease burden, particularly among those with migraine and PTH. Improving care coordination, integrating patient navigation services, and prioritizing outreach to socially isolated Veterans may improve headache management and reduce long-term disability.
