Burn Pit Exposure Linked to Migraine, Headache Disorders in US Veterans

Jason J. Sico, MD, MHS

Credit: Yale School of Medicine

A new study revealed open burn pit exposure is associated with migraine and headache disorders in US veterans.¹

“These data indicate that the greater the amount of open burn pit exposure service members experience, the more likely they are to develop new-onset headache,” investigators wrote, led by Jason J. Sico, MD, MHS, the director of research and clinical care at the Headache Center of Excellence at the US Department of Veterans Affairs (VA) in Connecticut.

Evidence indicates airborne hazards, which refer to any chemical, physical, or biological agent that is inhaled, may be a risk factor for headache disorders. For instance, studies have reported many 9/11 survivors and first responders, surrounded by debris from the fallen World Trade Centers, developed incident headache disorders.² Among a sample of 8418 adults who survived collapsed buildings or buildings with major or moderate damage, 21.0% reported severe headaches.

Another study provided evidence that air pollution triggers migraine attacks.³ The analysis showed point estimates > 1.00, which described carbon monoxide, nitrogen dioxide, ozone, PM2.5, PM10, black carbon, methane, sulfur dioxide, industrial toxic waste, and proximity to oil and gas wells, were associated with an increased migraine risk.

Open burn pits, used frequently by the US military for waste disposal, are believed to contain toxic compounds, such as polycyclic aromatic hydrocarbons, volatile organic compounds, and heavy metals.¹ The military has used open burn pits in Iraq, Afghanistan, and other areas of Southwest Asia, unaware of their full medical consequences.

The US Congress enacted Public Law 112-260 in 2013 so the US Department of Veterans Affairs (VA) would establish the Airborne Hazards and Open Burn Pit Registry for service members who may have been exposed to airborne hazards from open burn pits. The intention for this was to see whether open burn pit exposure was a source of lasting injury. In 2022, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxicities Act expanded health care benefits for veterans exposed to open burn pits, Agent Orange, and other toxins.

The US government may recognize, and act upon, the medical harms of open burn pits but more research is needed on the inflicted damages. For instance, were open burn pits linked to incident migraine?

Sico and colleagues assessed whether open burn pits were linked to incident migraine and headache disorders in a retrospective cohort study. The primary outcome was medically diagnosed headache disorders and migraine.

Investigators linked participant data (April 1, 2014, through October 31, 2022) from the Veterans Administration Headache Cohort and the US Department of Defense, and the Airborne Hazards and Open Burn Pit Registry. They collected data on open burn pit exposure composite variables, such as being open burn pits, days near open burn pits, and having open burn pit duties. The study excluded participants with preexisting headache disorders.

The sample included 247583 veterans with a mean age of 27.9 years and 89.9% male. An adjusted analysis showed participants with open burn pit duties had the greatest odds of diagnosed headache disorders (adjusted odds ratio [aOR], 1.59; 95% confidence interval [CI], 1.46 – 1.74), diagnosed 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.

Furthermore, those with the longest cumulative burn exposure (290 – 448 days and > 448 days) had significantly greater odds of diagnosed headline (aOR, 1.20; 95% CI, 1.09-1.31 and aOR, 1.55; 95% CI, 1.41-1.70, respectively) and migraine (aOR, 1.19; 95% CI, 1.07 – 1.34 and aOR, 1.48; 95% CI, 1.32 – 1.65, respectively).

“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 VHA facilities in the context of mandatory screening for military exposures as part of the Honoring our PACT Act of 2022,” investigators concluded.

References

1. ^{Sico JJ, Anthony SE, Phadke M, et al. Open Burn Pit Exposure in Headache Disorder and Migraine. JAMA Netw Open. 2024;7(9):e2431522. doi:10.1001/jamanetworkopen.2024.31522}
2. ^{Brackbill RM, Thorpe LE, DiGrande L, et al. Surveillance for World Trade Center disaster health effects among survivors of collapsed and damaged buildings. MMWR Surveill Summ. 2006;55(2):1-18.}
3. ^{Portt AE, Orchard C, Chen H, Ge E, Lay C, Smith PM. Migraine and air pollution: A systematic review. Headache. 2023;63(9):1203-1219. doi:10.1111/head.14632}