New-Onset Headaches Increase in the Aftermath of World Trade Center Attacks
TORONTO—Headache is common and persistent among local residents and workers who were exposed to dust and fumes near the site of the September 11, 2001, attacks on the World Trade Center in New York City, according to findings presented at the 62nd Annual Meeting of the American Academy of Neurology.
About 43% of community members presenting for medical care reported new-onset headache after the terror attacks, reported lead investigator Katherine A. Henry, MD, and colleagues. Among this group, 55% were exposed to the initial dust cloud that resulted from the collapse of the two towers from the World Trade Center.
“Exposure to the initial dust cloud was a risk for headache,” said Dr. Henry, Associate Professor of Neurology, New York University School of Medicine in New York City. “Headache was also associated with new gastroesophageal reflux disease, nasal drip and sinus congestion, and respiratory symptoms after 9/11.”
More Fallout From 9/11
The collapse of the Twin Towers generated the release of pulverized and combusted material in the form of a large dust cloud, and the persistence of dust and fumes in areas surrounding the site resulted from resuspended particles and fires. About 300,000 people were living and/or working near the site and were potentially exposed to the dust and fumes, which lingered in the area for four months.
“True exposure assessments in these populations are not possible, but dust cloud exposure represents one scenario of massive exposure,” noted Dr. Henry. “Serious immediate and persistent physical and psychologic problems have been well-described in the first responders and in the local community.”
Although most health studies of illnesses related to the World Trade Center have focused on respiratory and gastrointestinal problems, a previous study by the New York University group found that 21% of persons living and working in the area had severe headache after 9/11. Frequent headaches have also been reported among other disaster survivors, including manmade incidents such as the sarin gas attack in Japan and nuclear fallout from Chernobyl and Three Mile Island, as well as natural disasters such as Hurricane Katrina, according to Dr. Henry and her coinvestigators, Sara Crystal, MD, and Joan Reibman, MD.
“The presence of persistent headache in community members presenting for medical care for 9/11-related illnesses is unknown,” commented Dr. Henry. “We hypothesized that headache would be a common and persistent medical complaint in those presenting for medical care in the aftermath of 9/11 and would be associated with initial dust cloud exposure.”
Frequency of New-Onset Headaches
Dr. Henry’s group included 802 consecutive patients who were enrolled in the Bellevue Hospital WTC Environmental Health Center after December 2005. Each subject was interviewed to document exposure to dust and fumes following the attacks and frequency of headache in the preceding four weeks. The investigators also documented the incidence of gastroesophageal reflux disease, nasal/sinus symptoms, dyspnea on exertion, and wheezing during the same period. Thirty-eight patients had headache prior to 9/11 and were therefore excluded from the analysis.
The mean age of participants was 49 (50% male; 32% Hispanic), while the mean age of those with frequent headaches was 48. “More Hispanic patients than non-Hispanic patients reported frequent headache,” reported Dr. Henry. “A lower education and income were associated with frequent headache.”
Among participants who had frequent headache, more than 60% of them reported having exposure to the initial dust cloud from the World Trade Center. Those with frequent headache were also more likely to have physical symptoms such as dyspnea with exertion (81%), nasal drip and sinus congestion (69%), and gastroesophageal reflux disease (56%).
“These data suggest that headache is a common and persistent symptom in community members exposed to World Trade Center dust/fumes,” commented Dr. Henry. “Further studies are warranted to better characterize the headache and to understand the interplay between headache and other physical and mental health symptoms.”
—Colby Stong
Suggested Reading
Berríos-Torres SI, Greenko JA, Phillips M, et al. World Trade Center rescue worker injury and illness surveillance, New York, 2001. Am J Prev Med. 2003;25(2):79-87.
Osinubi OY, Gandhi SK, Ohman-Strickland P, et al. Organizational factors and office workers’ health after the World Trade Center terrorist attacks: long-term physical symptoms, psychological distress, and work productivity. J Occup Environ Med. 2008;50(2):112-125.
Headache and Mental Health Symptoms Related to World Trade Center Attacks
LOS ANGELES—Headaches are associated with probable posttraumatic stress disorder (PTSD) and symptoms of depression and anxiety among residents and workers presenting for medical care after the 9/11 World Trade Center attacks, according to research presented by Katherine A. Henry, MD, and colleagues at the 52nd Annual Meeting of the American Headache Society.
