{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T16:18:17Z","timestamp":1788797897327,"version":"build-2803163510"},"reference-count":51,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Migraine is a prevalent and debilitating condition that substantially impacts quality of life. Investigating migraine prevalence, associated comorbidities, and potential military service exposures in veterans, focusing on gender differences, is crucial for targeted interventions and management strategies.<\/jats:p><\/jats:sec>Objective<\/jats:title>To determine the prevalence of migraine, associated health comorbidities, and potential military service and environmental exposures among men and women US veterans using a large-scale epidemiological sample from the Million Veteran Program (MVP).<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cross-sectional study analyzed self-report survey data from the MVP, a large epidemiological sample of US veterans that was started in 2011 and has ongoing enrollment. Eligible participants were selected from the MVP database in 2023. The study included 491\u202f604 veterans to examine migraine prevalence, health comorbidities, demographic characteristics, military service history, and environmental exposures. Data were analyzed from December 2022 to July 2023.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Military service and environmental factors, such as chemical or biological warfare exposure, were considered.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was migraine prevalence among men and women veterans, assessed through self-reported diagnoses. Secondary outcomes included the association between migraine and health comorbidities, demographic characteristics, military service history, and environmental exposures.<\/jats:p><\/jats:sec>Results<\/jats:title>Of the 491\u202f604 veterans included in this study, 450\u202f625 (91.8%) were men and 40\u202f979 (8.2%) were women. The lifetime prevalence of migraine was significantly higher in women (12\u202f324 of 40\u202f979 [30.1%]) than in men (36\u202f816 of 450\u202f625 [8.2%]). Migraine prevalence varied by race and ethnicity, with the highest prevalence in Hispanic or Latinx women (1213 of 3495 [34.7%]). Veterans with migraine reported worse general health, higher levels of pain, increased pain interference with work, a higher likelihood of psychiatric and neurological health conditions, and greater lifetime opioid use. Specific aspects of military service, including service post-September 2001 and deployment in Operation Enduring Freedom and Operation Iraqi Freedom, and environmental factors, including Agent Orange, chemical and biological welfare, and antinerve agent pills history, were significantly associated with migraine prevalence.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cross-sectional study of migraine, the results highlighted gender differences in migraine prevalence and associated health comorbidities among US veterans. The findings emphasized the need for interdisciplinary approaches to migraine management, increased awareness and education efforts, and population-based screening strategies, particularly for women and Hispanic veterans who are at greater risk. Our findings encourage further research into tailored interventions for specific subpopulations and the impact of military service and environmental exposures on migraine and related health conditions.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.2299","type":"journal-article","created":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T15:01:27Z","timestamp":1710428487000},"page":"e242299","source":"Crossref","is-referenced-by-count":19,"title":["Migraine Prevalence, Environmental Risk, and Comorbidities in Men and Women Veterans"],"prefix":"10.1001","volume":"7","author":[{"given":"Marianna","family":"Gasperi","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle"},{"name":"Veteran Affairs (VA) Puget Sound Health Care System, Seattle, Washington"},{"name":"VA Northwest Mental Illness Research, Education and Clinical Center VA Puget Sound Health Care System, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathaniel M.","family":"Schuster","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of California, San Diego, La Jolla"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brooke","family":"Franklin","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline M.","family":"Nievergelt","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of California, San Diego, La Jolla"},{"name":"VA San Diego Health Care System, San Diego, California"},{"name":"VA Center of Excellence for Stress and Mental Health, VA San Diego Health Care System, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murray B.","family":"Stein","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of California, San Diego, La Jolla"},{"name":"VA San Diego Health Care System, San Diego, California"},{"name":"Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niloofar","family":"Afari","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of California, San Diego, La Jolla"},{"name":"VA San Diego Health Care System, San Diego, California"},{"name":"VA Center of Excellence for Stress and Mental Health, VA San Diego Health Care System, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,3,14]]},"reference":[{"issue":"1","key":"zoi240108r1","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1111\/head.v61.1","article-title":"The prevalence and impact of migraine and severe headache in the United States: updated age, sex, and socioeconomic-specific estimates from government health surveys.","volume":"61","author":"Burch","year":"2021","journal-title":"Headache"},{"issue":"3","key":"zoi240108r2","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1111\/head.2016.56.issue-3","article-title":"A cohort study examining headaches among veterans of Iraq and Afghanistan wars: associations with traumatic brain injury, PTSD, and depression.","volume":"56","author":"Jaramillo","year":"2016","journal-title":"Headache"},{"key":"zoi240108r3","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.jpsychires.2018.03.004","article-title":"Postconcussive symptoms (PCS) following combat-related traumatic brain injury (TBI) in veterans with posttraumatic stress disorder (PTSD): influence of TBI, PTSD, and depression on symptoms measured by the Neurobehavioral Symptom Inventory (NSI).","volume":"102","author":"Porter","year":"2018","journal-title":"J Psychiatr Res"},{"issue":"5","key":"zoi240108r4","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1111\/head.2010.50.issue-5","article-title":"Headache triggers in the US military.","volume":"50","author":"Theeler","year":"2010","journal-title":"Headache"},{"issue":"6","key":"zoi240108r5","doi-asserted-by":"publisher","first-page":"883","DOI":"10.1111\/hed.2008.48.issue-6","article-title":"The prevalence and impact of migraine on US Military officer trainees.","volume":"48","author":"Helseth","year":"2008","journal-title":"Headache"},{"issue":"18","key":"zoi240108r6","doi-asserted-by":"publisher","first-page":"e1979","DOI":"10.1212\/WNL.0000000000200888","article-title":"Frequency, demographics, comorbidities, and health care utilization by veterans with migraine: a VA nationwide cohort study.","volume":"99","author":"Seng","year":"2022","journal-title":"Neurology"},{"issue":"4","key":"zoi240108r7","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1111\/head.2018.58.issue-4","article-title":"The prevalence and impact of migraine and severe headache in the United States: figures and trends from government health studies.","volume":"58","author":"Burch","year":"2018","journal-title":"Headache"},{"issue":"1","key":"zoi240108r8","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1177\/0333102416631959","article-title":"Increase in migraine diagnoses and guideline-concordant treatment in veterans, 2004-2012.","volume":"37","author":"Altalib","year":"2017","journal-title":"Cephalalgia"},{"issue":"3","key":"zoi240108r9","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1016\/j.jpain.2016.10.021","article-title":"Severe pain in veterans: the effect of age and sex, and comparisons with the general population.","volume":"18","author":"Nahin","year":"2017","journal-title":"J Pain"},{"issue":"5","key":"zoi240108r10","doi-asserted-by":"publisher","first-page":"732","DOI":"10.1111\/hed.2012.52.issue-5","article-title":"Chronic daily headache in U.S. soldiers after concussion.","volume":"52","author":"Theeler","year":"2012","journal-title":"Headache"},{"issue":"9","key":"zoi240108r11","doi-asserted-by":"publisher","first-page":"1267","DOI":"10.1111\/hed.2009.49.issue-9","article-title":"PTSD, combat injury, and headache in veterans returning from Iraq\/Afghanistan.","volume":"49","author":"Afari","year":"2009","journal-title":"Headache"},{"issue":"3","key":"zoi240108r12","doi-asserted-by":"publisher","DOI":"10.4088\/PCC.17m02118","article-title":"Mental and physical health conditions in US combat veterans: results from the national health and resilience in veterans study.","volume":"19","author":"Thomas","year":"2017","journal-title":"Prim Care Companion CNS Disord"},{"issue":"5","key":"zoi240108r13","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1056\/NEJMoa072972","article-title":"Mild traumatic brain injury in US soldiers returning from Iraq.","volume":"358","author":"Hoge","year":"2008","journal-title":"N Engl J Med"},{"issue":"6","key":"zoi240108r15","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1177\/0333102420909865","article-title":"Persistent post-traumatic headache attributed to mild traumatic brain injury: deep phenotyping and treatment patterns.","volume":"40","author":"Ashina","year":"2020","journal-title":"Cephalalgia"},{"issue":"1","key":"zoi240108r16","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1186\/s10194-020-01122-5","article-title":"Persistent post-traumatic headache: a migrainous loop or not? the clinical evidence.","volume":"21","author":"Labastida-Ram\u00edrez","year":"2020","journal-title":"J Headache Pain"},{"issue":"1","key":"zoi240108r18","doi-asserted-by":"publisher","first-page":"111","DOI":"10.3390\/ijerph16010111","article-title":"Gulf War illness: unifying hypothesis for a continuing health problem.","volume":"16","author":"Mawson","year":"2019","journal-title":"Int J Environ Res Public Health"},{"issue":"7","key":"zoi240108r19","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1136\/jnnp-2015-312233","article-title":"Migraine and its psychiatric comorbidities.","volume":"87","author":"Minen","year":"2016","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"1","key":"zoi240108r20","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1186\/s10194-020-01192-5","article-title":"Migraine and sleep disorders: a systematic review.","volume":"21","author":"Tiseo","year":"2020","journal-title":"J Headache Pain"},{"issue":"6","key":"zoi240108r21","doi-asserted-by":"publisher","first-page":"872","DOI":"10.1111\/head.v61.6","article-title":"Characterization of chronic overlapping pain conditions in patients with chronic migraine: a CHOIR study.","volume":"61","author":"Barad","year":"2021","journal-title":"Headache"},{"issue":"7","key":"zoi240108r22","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1111\/head.v58.7","article-title":". Identifying natural subgroups of migraine based on comorbidity and concomitant condition profiles: results of the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study.","volume":"58","author":"Lipton","year":"2018","journal-title":"Headache"},{"issue":"1","key":"zoi240108r23","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s10194-020-1084-y","article-title":"Comorbid and co-occurring conditions in migraine and associated risk of increasing headache pain intensity and headache frequency: results of the migraine in America symptoms and treatment (MAST) study.","volume":"21","author":"Buse","year":"2020","journal-title":"J Headache Pain"},{"issue":"3","key":"zoi240108r24","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1111\/head.2017.57.issue-3","article-title":"Untangling the association between migraine, pain, and anxiety: examining migraine and generalized anxiety disorders in a canadian population based study.","volume":"57","author":"Fuller-Thomson","year":"2017","journal-title":"Headache"},{"issue":"6","key":"zoi240108r25","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1136\/jnnp-2018-318254","article-title":"Migraine and risk of stroke.","volume":"91","author":"\u00d8ie","year":"2020","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"9","key":"zoi240108r26","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1038\/s41582-021-00516-6","article-title":"Headache in people with epilepsy.","volume":"17","author":"Bauer","year":"2021","journal-title":"Nat Rev Neurol"},{"issue":"1","key":"zoi240108r27","doi-asserted-by":"publisher","DOI":"10.1212\/NXG.0000000000000653","article-title":"Migraine, stroke, and cervical arterial dissection: shared genetics for a triad of brain disorders with vascular involvement.","volume":"8","author":"Daghlas","year":"2022","journal-title":"Neurol Genet"},{"key":"zoi240108r28","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2021.686398","article-title":"Metabolic aspects of migraine: association with obesity and diabetes mellitus.","volume":"12","author":"Rivera-Mancilla","year":"2021","journal-title":"Front Neurol"},{"key":"zoi240108r29","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2020.609528","article-title":"The comorbid relationship between migraine and asthma: a systematic review and meta-analysis of population-based studies.","volume":"7","author":"Wang","year":"2021","journal-title":"Front Med (Lausanne)"},{"issue":"11","key":"zoi240108r30","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1097\/JXX.0000000000000539","article-title":"Headache management in a veteran population: First considerations.","volume":"32","author":"Williams","year":"2020","journal-title":"J Am Assoc Nurse Pract"},{"key":"zoi240108r31","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1111\/head.2018.58.issue-S1","article-title":"Migraine burden of disease: from the patient\u2019s experience to a socio-economic view.","volume":"58","author":"Agosti","year":"2018","journal-title":"Headache"},{"key":"zoi240108r32","doi-asserted-by":"publisher","first-page":"S39","DOI":"10.1016\/j.whi.2019.04.003","article-title":"Health status of female and male Gulf War and Gulf Era veterans: a population-based study.","volume":"29","author":"Dursa","year":"2019","journal-title":"Womens Health Issues"},{"key":"zoi240108r33","doi-asserted-by":"publisher","first-page":"S56","DOI":"10.1016\/j.whi.2019.04.012","article-title":"Gender differences in demographic and health characteristics of the Million Veteran Program cohort.","volume":"29","author":"Harrington","year":"2019","journal-title":"Womens Health Issues"},{"key":"zoi240108r34","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1016\/j.jpsychores.2017.08.011","article-title":"Gender differences in mental and physical health conditions in US veterans: results from the National Health and Resilience in Veterans Study.","volume":"101","author":"Ziobrowski","year":"2017","journal-title":"J Psychosom Res"},{"issue":"12","key":"zoi240108r35","doi-asserted-by":"publisher","first-page":"1359","DOI":"10.1007\/s11606-017-4152-5","article-title":"An evidence map of the women veterans\u2019 health research literature (2008-2015).","volume":"32","author":"Danan","year":"2017","journal-title":"J Gen Intern Med"},{"issue":"24","key":"zoi240108r36","doi-asserted-by":"publisher","first-page":"e2224","DOI":"10.1212\/WNL.0000000000008589","article-title":"Migraine progression in subgroups of migraine based on comorbidities: results of the CaMEO Study.","volume":"93","author":"Lipton","year":"2019","journal-title":"Neurology"},{"key":"zoi240108r37","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1016\/j.jclinepi.2015.09.016","article-title":"Million Veteran Program: a mega-biobank to study genetic influences on health and disease.","volume":"70","author":"Gaziano","year":"2016","journal-title":"J Clin Epidemiol"},{"issue":"3","key":"zoi240108r38","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1136\/jnnp.2005.073221","article-title":"Headache and migraine in primary care: consultation, prescription, and referral rates in a large population.","volume":"77","author":"Latinovic","year":"2006","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"2","key":"zoi240108r40","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1111\/head.2015.55.issue-2","article-title":"The prevalence, burden, and treatment of severe, frequent, and migraine headaches in US minority populations: statistics from National Survey studies.","volume":"55","author":"Loder","year":"2015","journal-title":"Headache"},{"issue":"1","key":"zoi240108r41","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/S1474-4422(16)30293-9","article-title":"Sex differences in the epidemiology, clinical features, and pathophysiology of migraine.","volume":"16","author":"Vetvik","year":"2017","journal-title":"Lancet Neurol"},{"issue":"7","key":"zoi240108r42","doi-asserted-by":"publisher","first-page":"1021","DOI":"10.1111\/head.v61.7","article-title":"The American Headache Society Consensus Statement: update on integrating new migraine treatments into clinical practice.","volume":"61","author":"Ailani","year":"2021","journal-title":"Headache"},{"issue":"5","key":"zoi240108r43","doi-asserted-by":"publisher","first-page":"e457","DOI":"10.1212\/WNL.0000000000009324","article-title":"Characterizing opioid use in a US population with migraine: results from the CaMEO study.","volume":"95","author":"Lipton","year":"2020","journal-title":"Neurology"},{"issue":"10","key":"zoi240108r44","doi-asserted-by":"publisher","first-page":"1651","DOI":"10.1111\/head.2013.53.issue-10","article-title":"Choosing wisely in headache medicine: the American Headache Society\u2019s list of five things physicians and patients should question.","volume":"53","author":"Loder","year":"2013","journal-title":"Headache"},{"issue":"10283","key":"zoi240108r45","doi-asserted-by":"publisher","first-page":"1505","DOI":"10.1016\/S0140-6736(20)32342-4","article-title":"Migraine: integrated approaches to clinical management and emerging treatments.","volume":"397","author":"Ashina","year":"2021","journal-title":"Lancet"},{"issue":"8","key":"zoi240108r46","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1038\/s41582-021-00509-5","article-title":"Diagnosis and management of migraine in ten steps.","volume":"17","author":"Eigenbrodt","year":"2021","journal-title":"Nat Rev Neurol"},{"issue":"3","key":"zoi240108r47","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1111\/ene.v27.3","article-title":"Poor patient awareness and frequent misdiagnosis of migraine: findings from a large transcontinental cohort.","volume":"27","author":"Viana","year":"2020","journal-title":"Eur J Neurol"},{"issue":"4","key":"zoi240108r48","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1111\/hed.2008.48.issue-4","article-title":"Comorbidity of migraine and psychiatric disorders\u2014a national population-based study.","volume":"48","author":"Jette","year":"2008","journal-title":"Headache"},{"issue":"1","key":"zoi240108r49","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1007\/s00127-019-01755-1","article-title":"Prevalence and comorbidity of migraine headache: results from the Singapore Mental Health Study 2016.","volume":"55","author":"Jeyagurunathan","year":"2020","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"issue":"10","key":"zoi240108r50","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.1111\/head.2015.55.issue-10","article-title":"The impact of post-traumatic stress disorder on the burden of migraine: results from the National Comorbidity Survey-Replication.","volume":"55","author":"Rao","year":"2015","journal-title":"Headache"},{"issue":"2","key":"zoi240108r51","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1177\/0333102410378051","article-title":"Post-traumatic stress disorder, drug abuse and migraine: new findings from the National Comorbidity Survey Replication (NCS-R).","volume":"31","author":"Peterlin","year":"2011","journal-title":"Cephalalgia"},{"key":"zoi240108r17","volume-title":"Medicine. Veterans and Agent Orange: Update 11","author":"National Academies of Sciences E","year":"2018"},{"key":"zoi240108r39","year":"2018"},{"key":"zoi240108r14","unstructured":"Traumatic Brain Injury Center of Excellence. Department of Defense Traumatic Brain Injury Worldwide Numbers. Accessed January 20, 2024. https:\/\/health.mil\/Military-Health-Topics\/Centers-of-Excellence\/Traumatic-Brain-Injury-Center-of-Excellence\/DOD-TBI-Worldwide-Numbers"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2816197\/gasperi_2024_oi_240108_1709918738.86302.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T15:01:32Z","timestamp":1710428492000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2816197"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,14]]},"references-count":51,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,3,4]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.2299","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,14]]}}}