Associations between Unconventional Natural Gas Development and Nasal and Sinus, Migraine Headache, and Fatigue Symptoms in Pennsylvania

Complete paper available at link: Associations between Unconventional Natural Gas Development and Nasal and Sinus, Migraine Headache, and Fatigue Symptoms in Pennsylvania by Aaron W. Tustin, Annemarie G. Hirsch, Sara G. Rasmussen, Joan A. Casey, Karen Bandeen-Roche, and Brian S. Schwartz, Received: 22 December 2015, Revised: 29 July 2016, Accepted: 31 July 2016, Published: 25 August 2016, Environ Health Perspect; DOI:10.1289/EHP281

Background: Unconventional natural gas development (UNGD) produces environmental contaminants and psychosocial stressors. Despite these concerns, few studies have evaluated the health effects of UNGD.

Objectives: We investigated associations between UNGD activity and symptoms in a cross-sectional study in Pennsylvania.

Methods: We mailed a self-administered questionnaire to 23,700 adult patients of the Geisinger Clinic. Using standardized and validated questionnaire items, we identified respondents with chronic rhinosinusitis (CRS), migraine headache, and fatigue symptoms. We created a summary UNGD activity metric that incorporated well phase, location, total depth, daily gas production and inverse distance-squared to patient residences. We used logistic regression, weighted for sampling and response rates, to assess associations between quartiles of UNGD activity and outcomes, both alone and in combination.

Results: The response rate was 33%. Of 7,785 study participants, 1,850 (24%) had current CRS symptoms, 1,765 (23%) had migraine headache, and 1,930 (25%) had higher levels of fatigue. Among individuals who met criteria for two or more outcomes, adjusted odds ratios for the highest quartile of UNGD activity compared to the lowest were [OR (95% CI)] 1.49 (0.78, 2.85) for CRS plus migraine, 1.88 (1.08, 3.25) for CRS plus fatigue, 1.95 (1.18, 3.21) for migraine plus fatigue, and 1.84 (1.08, 3.14) for all three outcomes together. Significant associations were also present in some models of single outcomes.

Conclusions: This study provides evidence that UNGD is associated with nasal and sinus, migraine headache, and fatigue symptoms in a general population representative sample.

There are concerns that UNGD could affect the environment via chemical pollutants such
as diesel exhaust, volatile organic compounds, combustion products, fugitive emissions, and fracking chemicals (Werner et al. 2015). UNGD has been linked to contamination of air (Macey et al. 2014; Paulik et al. 2015), soil (Maloney and Yoxtheimer 2012), groundwater (Jackson et al. 2013; Drollette et al. 2015), and surface water (Kassotis et al. 2014). UNGD also creates contextual and psychosocial stressors including noise, truck traffic, influxes of non-local workers, and perceived negative impacts on quality of life and the built and social environments (Saberi et al. 2014; Powers et al. 2015; Adgate et al. 2014).

We used data from a large population-based cross-sectional survey of Pennsylvania
adults to identify patients with nasal and sinus symptoms, migraine headache, and higher levels of fatigue. We selected these outcomes because of their high prevalence, large economic costs, and possible links to environmental risk factors through chemical toxicity, irritation, odors, or stress (Hastan et al. 2011; Bhattacharyya 2009; Shashy et al. 2004; Tan et al. 2013; Friedman and De ver Dye 2009; Sjostrand et al. 2010; Bell et al. 1998; Griffith and Zarrouf 2008; Ranjith 2005; Ricci et al. 2007). The purpose of this study was to test the null hypothesis that UNGD is not associated with these three outcomes. To do so, we conducted a case-control analysis in which we compared individuals with one or more of these health outcomes to selected participants with no or minimal evidence of these diseases.

UNGD activity assessment
We used published descriptions, and our own data, to estimate the duration of each
UNGD phase (Gaines 2013; New York State Department of Environmental Conservation 2015; Casey et al. 2016). Pad preparation, which involves the clearing of the well site, lasts
approximately 30 days. Drilling of the well then takes 1 to 30 days, proportionate to the total (vertical plus horizontal) depth. After drilling, hydraulic fracturing occurs during a stimulation (fracking) phase that lasts an average of 7 days. Finally, the well produces natural gas during a production phase that lasts months to years.

To capture these complexities of well development, we compiled data on UNGD in
Pennsylvania from January 1, 2005 through December 31, 2014, from the Pennsylvania
Department of Environmental Protection, the Pennsylvania Department of Conservation and Natural Resources, and SkyTruth ( For each well we obtained geographic coordinates; start dates of drilling, stimulation, and production; total depth; and volume of natural gas produced during six- or twelve-month reporting windows.


In our survey of primary care patients in central and northeast Pennsylvania, residential UNGD activity was associated with nasal and sinus symptoms, migraine headache, and higher levels of fatigue, either alone or in combination. Our findings are suggestive of a threshold in the relationship between UNGD and symptoms, as associations were present only among participants in the fourth quartile of UNGD activity. We found stronger associations in individuals with two or more co-occurring outcomes. In addition, UNGD was associated with CRS in individuals whose nasal and sinus symptoms began after the start of UNGD in Pennsylvania, although these estimates had lower precision due to the small number of subjects with recent CRS onset.

There is limited prior evidence linking environmental factors to CRS, migraine headache,
and fatigue. Exposure to allergens, toxicants, and secondhand smoke may trigger nasal and sinus symptoms (Fokkens et al. 2012). However, a recent review found insufficient epidemiologic evidence from which to draw conclusions about occupational or environmental risk factors for CRS (Sundaresan et al. 2015). Though migraines have a strong hormonal and genetic component, migraines can also be triggered by noise, odors, and stress (Friedman and De ver Dye 2009; Sjostrand et al. 2010; Sauro and Becker 2009). Similarly, fatigue has multiple risk factors including sleep deprivation, psychosocial stressors, medical disorders, psychiatric factors, occupation, and exposure to low levels of environmental chemicals (Bell et al. 1998; Ranjith 2005; Ricci et al. 2007; Griffith and Zarrouf 2008). Our UNGD activity metrics were designed to capture all potential environmental pathways that could affect these symptoms.

We did not measure participants’ exposure to ambient air pollution. We also did not
account for conventional oil and gas wells. During our study period the production of
conventional gas wells in Pennsylvania was very low compared to that of unconventional wells. Furthermore, Pennsylvania’s conventional wells tend to be in the northwest and west, where Geisinger has no patients. The lack of significant geographic overlap with our study population makes confounding of UNGD associations by conventional oil and gas wells unlikely.

CRS, migraine headache, and fatigue are highly prevalent and produce significant societal costs. CRS affects 2-16% of U.S. adults and results in emergency department visits, antibiotic prescriptions, sinus surgeries, and direct healthcare costs (Hastan et al. 2011; Bhattacharyya 2009; Shashy et al. 2004; Tan et al. 2013). Migraines have a prevalence of 11- 14% and cause substantial temporary disability, emergency department visits, outpatient clinic visits, and analgesic use (Lipton et al. 2007; Burch et al. 2015). Fatigue prevalence, defined in various ways across studies, is estimated at 7-45%, and fatigue costs U.S. employers over $100 billion per year in lost productive work time (Ricci et al. 2007). From a public health and economic perspective it is vital to understand modifiable risk factors for these illnesses. … [Emphasis added]

Living Near a Fracking Site Is Tied to Migraines, Fatigue by Nicholas Bakalar, August 25, 2016, New York Times
Living near a natural gas hydraulic fracturing site is associated with increased rates of sinus problems, migraines and fatigue, according to new research.

Scientists had 7,785 randomly selected participants in a large Pennsylvania health system fill out health questionnaires. About a quarter met criteria for one or more of three disorders: chronic rhinosinusitis, migraine headaches and severe fatigue.

The study, in Environmental Health Perspectives, ranked participants according to how closely they lived to fracking sites and larger wells. Compared with those in the bottom one-quarter by this measure, those in the top one-quarter were 49 percent more likely to have sinusitis and migraines, 88 percent more likely to have sinusitis and fatigue, 95 percent more likely to have migraines and fatigue, and 84 percent more likely to have all three symptoms.

The senior author, Dr. Brian S. Schwartz, a physician and environmental epidemiologist at the Johns Hopkins Bloomberg School of Public Health, acknowledged that there may be variables the researchers did not account for, and that this was an observational study that does not prove cause and effect.

But, he said, “there have now been seven or eight studies with different designs and in different populations, and while none is perfect, there is now a growing body of evidence that this industry is associated with impacts on health that are biologically plausible. Do we know the exact mechanism? No. That requires further study.” [Do families need to know exactly how fracing is poisoning them and harming their health? Emphasis added]

New Study Finds Living Near a Fracking Site Is Tied to Migraines & Fatigue Press Release by Pennsylvanians Against Fracking, August 25, 2016, Common Dreams

WASHINGTON – New research indicates that living near a natural gas hydraulic fracturing site is associated with increased rates of sinus problems, migraines and fatigue in Pennsylvania residents – a state that has over 9,700 fracking wells.

This study is the latest in mounting scientific evidence and research proving that fracking has severe health risks.  It follows a July 2016 Johns Hopkins study showing that fracking is linked to increased asthma attacks in Pennsylvania, a recent analysis of over 680 peer-reviewed studies that indicate ‘concerns for public health, air quality and water quality,’ and a compendium of peer-reviewed scientific papers, numerous government reports and findings, demonstrating the risks of fracking to public health, air and water quality, birth and infant health, the environment, and climate change.

“Enough is enough,” said Diane Sipe, Pennsylvania resident and Steering Committee Member of Pennsylvanians Against Fracking. “It is abundantly clear that fracking is harming people, and the only solution is to stop fracking. The people in this State do not deserve to be put in harm’s way by leaders who are choosing to ignore the dangers of fracking and related infrastructure. It is time for Governor Wolf to follow the example set in New York, and put the wellbeing of his constituents above the profits of the oil and gas industry and ban fracking in Pennsylvania once and for all.”

The full study from Environmental Health Perspectives can be found here. [Emphasis added]

Health Problems Tied to Fracking, Medical Researchers Say by Telesur TV, August 25, 2016

… There are correlations between hydraulic fracturing, or fracking, and a range of health issues for Pennsylvania residents, including nasal and sinus problems, migraines and fatigue, according to a study released on Thursday by the Johns Hopkins University in Baltimore.

The report, “Environmental Health Perspectives,” is the school’s third study over the span of the last year, focusing on the adverse health effects of the controversial method for extracting gas from solid rock deposits, increasingly used in Pennsylvania.

Last fall, researchers from the Maryland-based Johns Hopkins Bloomberg School of Public Health, found an association between fracking and high-risk pregnancies and premature births, and in July also found ties between fracking and asthma.

… Most of the oil companies that extract gas through fracking claim that their technology is safe and last year the Obama administration, through the Environmental Protection Agency, said in a report that fracking isn’t causing widespread damage to the nation’s drinking water.

However studies like the John Hopkins one, show that these claims are untrue. Additionally, the news site, Common Dreams reports that a 2014 investigation revealed that health workers in Pennsylvania were silenced by the Pennsylvania State Department of Health and told not to respond to health inquiries that used certain fracking “buzzwords.”

According to the most recent Gallup poll, support for fracking among U.S. citizens has slipped to 36 percent, while opposition has climbed to 51 percent. [Emphasis added]

New Johns Hopkins Study Links Migraine to Fracking 

A new study published on Thursday has found that fracking is associated with migraine headache, nasal and sinus, and fatigue symptoms among residents in Pennsylvania, where more than 8,800 hydraulic fracturing wells have been drilled in the past decade.

Researchers at the Johns Hopkins Bloomberg School of Public Health sent in 2014 a questionnaire to adults in central and northeastern Pennsylvania and received responses from 33 percent of participants. The research found that out of 7,785 study participants, 24 percent had chronic rhinosinusitis (CRS), 23 percent had migraine headache, and 25 percent had reported high levels of fatigue.

“We don’t know specifically why people in close proximity to these larger wells are more likely to be sick,” Brian S. Schwartz, the study’s senior author and a professor in the Department of Environmental Health Sciences at the Bloomberg School, said on the website.

“We need to find a way to better understand the correlation and, hopefully, do something to protect the health of these people,” he noted.

This is not the first study that Schwartz has co-authored in the past few months. In July, the American Medical Association’s Journal of Internal Medicine released the results of a study that documented a correlation between fracking activities and an increased risk of asthma exacerbations for nearby residents.

Unconventional natural gas development (UNGD) has previously been associated with air quality disturbances [Disturbances? Why not report “toxic and mystery chemicals polluting” the air families need to breath?”], which can lead to the exacerbation of asthma symptoms.

Schwartz led the research team, which included 35,508 asthma patients who visited the Geisinger Clinic in Pennsylvania from 2005 to 2012.

Pennsylvania’s rise as a major user of UNGD techniques between the years 2005 to 2013 caught the researchers’ interest. A total of 6,253 wells of the kind began drilling in the state during the time period studied, while 4,728 were stimulated and 3,706 were in production. [Emphasis added]

[Refer also to:

2016 08 21: Rocky View County Alberta: Municipal councilors fail to support clean air and water, Voted clean air and water out of bounds, OK for frac’ers to poison families and environment

2016 04 26: New peer-reviewed published paper on unconventional natural gas development (excluding CBM/CSG) impacts: “At least 685 papers have been published in peer-reviewed scientific journals that are relevant to assessing the impacts of UNGD. 84% of public health studies contain findings that indicate public health hazards, elevated risks, or adverse health outcomes; 69% of water quality studies contain findings that indicate potential, positive association, or actual incidence of water contamination; and 87% of air quality studies contain findings that indicate elevated air pollutant emissions and/or atmospheric concentrations” ]

This entry was posted in Global Frac News. Bookmark the permalink.