The first treatment specifically designed for post-traumatic head pain significantly reduced the severity of disability among veterans who suffered an injury to the brain (TBI). It also helped reduce co-occurring signs related to post-traumatic anxiety disorder (PTSD) in comparison to a standard gold PTSD treatment.
Furthermore, the novel method, Cognitive Behavioral Therapy for Headache (CBTH) was very popular with patients. It has low rates of dropout, and it is simple for therapists to master and practice which increases its ability to be widely disseminated to make a difference to the lives of a large number of veterans and service members.
The findings were published on the 21st of April in the journal JAMA Neurology by a group of researchers headed by Don McGeary, PhD, of The University of Texas Health Science Center at San Antonio (UT Health San Antonio). Their research is one of the activities of the Consortium to Reduce PTSD which is a consortium with The Departments of Defense and Veterans Affairs.
“We are thrilled by this breakthrough for the treatment of post-traumatic headaches as well as TBI is not well understood and treatments are insufficient,” said Dr. McGeary who is an associate professor of psychiatry, behavioral and clinical sciences within the school’s Joe R. and Teresa Lozano Long School of Medicine. “To discover the first significant treatment for post-traumatic headache that is often regarded as the most debilitating symptom associated with TBI and also that it also reduces the comorbid PTSD symptoms is a significant breakthrough.”
Both TBI as well as PTSD are the most infamous wounds from post-9/11 wars both of which often occur in tandem. Post-traumatic headaches are headaches which develop or get worse due to a neck or head injury, can become persistent and debilitating for the majority of people suffering from a TBI like concussion, which can hinder their ability to take part in activities of everyday life. If PTSD is co-occurring with PTSD, it can exacerbate symptoms of headaches which can make the headaches harder to manage.
Effective treatment options exist that work for PTSD however, there are no effective treatments for post-traumatic headaches, which together with TBI researchers are studying. The majority of migraine medications employed to ease headache pain don’t relieve the disability. There are also a lot of unwelcome adverse effects and use can cause headaches.
Doctor. McGeary explained current theory that PTSD might be an “driver” for post-traumatic headache and the disabilities it creates. The research team decided to examine the relationship of these conditions as well as their treatment as well as to identify an effective treatment for both.
The study
The Dr. McGeary and his colleagues have developed CBTH by altering an approach to psychotherapy for migraine headaches. Through this research, they assessed its effectiveness in conjunction with symptoms of post-traumatic headache as well as PTSD.
The study was conducted at the Polytrauma Rehab Centre within the South Texas Veterans Health Care System. Participants presented with the clinical expression of significant PTSD symptoms as well as headaches that lasted for more than three months after an TBI. The participants were assigned either CBTH, a well-known PTSD treatment known as Cognitive Processing Therapy (CPT) or the standard care provided by the VA Polytrauma Center.
CBTH is a method of using the concepts of cognitive behavior therapy to decrease headache-related disability and improve mood. It includes essential elements such as relaxation and setting goals for the things patients would like to do and planning for these situations.
CPT is a renowned psychotherapy for PTSD which teaches sufferers how to assess and modify the negative thoughts and feelings that lead to their experiences and the belief that by altering your thinking patterns, you can alter how you feel.
The usual treatment in the VA Polytrauma Center is a top-quality care which may include injections therapy, occupational and physical therapy including pain medications Massage, acupuncture, and even long-term medical attention.
Findings from research
What the researchers discovered after the treatments was that when compared to standard care, patients who received CBTH experienced substantial reductions in disabilities as well as in adverse effects on functioning and living quality. Also, they saw improvement in PTSD symptoms that were similar to those of those who received CPT. The gains from treatment were sustained for six months following treatment was completed.
CPT however, in contrast has led to significant and long-lasting improvements on PTSD symptoms, however by itself, it did not help with headaches. “This was a shock,” the doctor. McGeary. “If theories regarding PTSD that cause post-traumatic headaches are accurate, you’d think CPT to aid in both PTSD in addition to headache. Our research calls that into an open question.”
Interpreting results
It is interesting to note that CBTH didn’t reduce headache frequency or intensity in comparison to standard treatment. The doctor. McGeary said its dramatic reductions in negative life impacts is likely to be due to creating confidence in patients that they can manage or control their headaches which is a notion known in the field of “self-efficacy.” This feeling of control was crucial in aiding patients “get their life back,” he said.
“If you can increase confidence in a person’s ability to can manage their headache it will improve their performance,” Dr. McGeary explained. “That’s because when confronted with a long-term debilitating pain condition People make decisions on whether or not they’ll engage in any activities, particularly if that activities aggravate the pain. They base these decisions on their beliefs about their capacity to manage their discomfort.”
The Dr. McGeary believes the planning aspect of CBTH is crucial to changing the perceptions. He stated, “There’s a big difference between saying , ‘I’ve got attend this event. What do I do?’, and “I have some plans to make this happen. I’m bringing my sunglasses so that they block out bright sunlight. I’ll also bring an ice pack. I’ll leave in the event that the noise becomes too loud. The process of creating plans helps people feel that they have increased their self-efficacy in controlling the headaches.”
Concerning the relief of PTSD symptoms regarding PTSD, Doctor. McGeary said it’s surprising that CBTH and CPT were similar. He believes that CBTH is more popular with patients, and as a result, less patients dropped out, and more were able to receive an entire dose of treatment. CBTH has fewer and less therapy sessions, typically eight sessions lasting 30-45 minutes each. CPT will be more difficult therapy, and usually involves 12 sessions of 60-90 minutes each.
Another advantage to CBTH can be that it takes just two hours of training for practitioners to provide the treatment, in contrast to CPT which is a complicated treatment that requires extensive training and the acquisition of skills. It is simple to increase the number of therapists who can treat veterans suffering from post-traumatic headache and lessen the burden on clinics.
The next steps
After the positive experience with the veterans of San Antonio, Dr. McGeary and his colleagues are now trying for ways to reproduce their results with an even larger group of. In a new study in the STRONG Star Consortium, they will evaluate the effectiveness of CBTH through a larger test across a variety of military and VA sites across in the United States.
“Dr. McGeary explained, “We have a need for more women as well as more ethnic and racial diversity and veterans, as well as active military members from various branches, with various co-morbidities, from different geographical regions, with different medical and hospitals because we’re comparing our care to the usual.”
Reference: McGeary DD, Resick PA, Penzien DB, et al. Cognitive treatment for veterans suffering from posttraumatic headaches and symptoms of posttraumatic stress A clinical trial that is randomized. JAMA Neurol. 2022. doi: 10.1001/jamaneurol.2022.1567
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