Prazosin could prevent headaches caused by traumatic brain injury

USA: Prazosin is in a class of medications called alpha-blockers that works by relaxing the blood vessels so that blood can flow more easily through the body.

Prazosin is used alone or in combination with other medications to treat high blood pressure.It is also used to treat benign prostatic hyperplasia (BPH), congestive heart failure, pheochromocytoma , sleep problems associated with post-traumatic stress disorder (PTSD) and Raynaud's disease.

Researchers have found in a new study that Prazocin may be effective against  prophylaxis of posttraumatic headaches in active-duty service members and veterans. However, the researchers suggest a larger randomized controlled trial to confirm and extend these promising results.

The study results appeared in the June 14, 2023, issue of Headache, the Journal of Head and Face Pain.

Senior study author Dr. Murray Raskind, director of the VA Northwest Mental Illness Research, Education and Clinical Center in Seattle, Washington, explained that few treatment options exist for this type of headache.

“Persistent posttraumatic headaches are the most common long-term consequence of mild traumatic brain injuries (concussions) in Veterans and active-duty service members, causing substantial distress and disability at home and work. Although these headaches usually resemble migraine headaches symptomatically, they often fail to respond to the prevention treatments useful for migraines,” said Raskind.

The FDA approved prazosin to treat hypertension in 1976. It has been widely used “off-label” to treat conditions such as PTSD-associated nightmares and enlarged prostate. An earlier study by research group members suggested that prazosin could reduce the frequency and severity of headaches caused by traumatic brain injury (TBI).

To test this effect, the researchers conducted a pilot study with 48 Veterans and service members with headaches caused by mild TBI, also known as a concussion. Participants took gradually increasing doses of prazosin for five weeks before receiving the maximum dose for 12 weeks. The study showed that the drug was well-tolerated, and researchers reported that morning drowsiness was the only adverse effect.

Before the trial began, study participants had an average of 18 headache days each month. By the end of the 12 weeks, those taking prazosin only had headaches for an average of six days a month. Participants receiving a placebo reported some reduction in headaches but still had headaches about 12 days a month. Significantly more participants in the prazosin group had at least 50% fewer headaches during the 12 weeks of taking a full dose of medication.

Participants taking prazosin also saw significant decreases in how much headaches impacted their quality of life. By the end of the trial, those taking prazosin reported that headaches had “some impact” on their daily ability to function, while participants given a placebo continued to report a “severe impact” of headaches.

According to the researchers, larger clinical trials are needed to confirm the extent of these promising results. Still, these initial findings offer a potential relief for a common ailment many Veterans face.

“This study is the only clinical trial of an oral medication to demonstrate efficacy for posttraumatic headache. Because prazosin is widely used across VA and the Department of Defense to treat PTSD trauma nightmares and sleep disruption, many VA and DOD prescribers are familiar with prescribing this generically available, inexpensive medication,” said Raskind. “Prazosin now offers an evidence-based approach to alleviate the suffering of Veterans and service members who have struggled for years with frequent posttraumatic headaches.”

TBI has been called the “signature injury” of the recent wars in Iraq and Afghanistan. Since 2000, more than 460,000 service members have sustained a TBI, most of which were mild TBIs. Headaches are common following a mild TBI, and they often become chronic and cause substantial disability and distress.

Reference:

Cindy L. Mayer, Paul J. Savage, Conner K. Engle, Soleil S. Groh, Jane B. Shofer, Ameryth M. Hargrove, Tammy J. Williams, Eileen L. Poupore, Kimberly L. Hart, PA-C, Ronald G. Riechers II , Robert L. Ruff, Elaine R. Peskind, Murray A. Raskind, Published: 14 June 2023 https://doi.org/10.1111/head.14529