Cognitive Behavioral Therapy significantly reduces headache disability, PTSD following brain injury

SAN ANTONIO: Cognitive Behavioral Therapy is the first therapy to be developed specifically for post-traumatic headache that may significantly reduce related disability in veterans following a traumatic brain injury (TBI). It may also reduce co-occurring symptoms of post-traumatic stress disorder (PTSD) comparably to a gold-standard PTSD treatment.

Moreover, the innovative treatment, Cognitive Behavioral Therapy for Headache (CBTH), was appealing to patients, showing low drop-out rates, and is easy for therapists to learn and deliver, increasing its potential to be broadly disseminated and to improve the lives of hundreds of thousands of service members and veterans.

Those findings were reported today in JAMA Neurology by a team of investigators led by Don McGeary, PhD, of The University of Texas Health Science Center at San Antonio (UT Health San Antonio). Their effort was part of the work of the Consortium to Alleviate PTSD, a group jointly funded by the Departments of Defense and Veterans Affairs.

"We are excited by this development in the treatment of post-traumatic headache, which along with TBI is poorly understood and for which treatment options are so limited," said Dr. McGeary, associate professor of psychiatry and behavioral sciences in the university's Joe R. and Teresa Lozano Long School of Medicine. "To find the first major treatment success for post-traumatic headache, which is arguably the most debilitating symptom of TBI, and that the treatment also significantly reduces comorbid PTSD symptoms, is a major breakthrough."

Both TBI and PTSD are signature wounds of post-9/11 military conflicts, and the two conditions commonly occur together. Post-traumatic headaches, or headaches that develop or worsen following a head or neck injury, become chronic and debilitating in a large percentage of those who experience a TBI such as a concussion, inhibiting their ability to engage in the activities of daily life. When PTSD is co-occurring, it can worsen the headaches and make them more difficult to treat.

Effective treatments exist for PTSD but not for post-traumatic headache, which along with TBI, scientists are still working to understand. Migraine medications commonly used to alleviate the headache pain do not relieve related disability. They also often have unwanted side effects, and their overuse can worsen headaches.

Dr. McGeary explained current theory that PTSD may be a "driver" of post-traumatic headache and the disability it causes. So the research team wanted both to study the interaction of the conditions and their treatment and to find a therapy effective for both.

Reference:

Donald D. McGeary, Patricia A. Resick, Donald B. Penzien, Cindy A. McGeary, Timothy T. Houle, Blessen C. Eapen, Carlos A. Jaramillo,  Paul S. Nabity, David E. Reed 2nd, John C. Moring, Lindsay M. Bira, Hunter R. Hansen, Stacey Young-McCaughan, RN, Briana A. Cobos, Jim Mintz,Terence M. Keane, Alan L. Peterson, DOI 10.1001/jamaneurol.2022.1567