An Effective Treatment for Post-Traumatic Stress Headaches in Veterans
Post by Megan McCullough
The takeaway
Cognitive behavioral therapies are an effective treatment for veterans with post-traumatic headaches and post-traumatic stress disorder symptoms.
What's the science?
Veterans are more at risk for developing post-traumatic headache (PTH) associated with mild traumatic brain injuries compared to civilians. There are no current treatments for PTH, but previous research suggests that cognitive behavioral therapy (CBT) could offer a safe and effective treatment. Although previous studies have found no benefit of CBT for treating PTH in civilians, veterans could respond differently to treatment because of their higher risk of post-traumatic stress disorder (PTSD) symptoms. This week in JAMA Neurology, McGeary and colleagues tested the efficacy of CBT compared to usual treatments in veterans with mild traumatic brain injury-related headaches and symptoms of PTSD.
How did they do it?
Participants included 193 combat veterans with PTH and PSTD symptoms. Participants were randomized into one of three groups: cognitive behavioral therapy for headaches, cognitive processing therapy, and usual care. Treatment was administered over the course of 6 weeks and participants completed pre-treatment assessments, post-treatment assessments, and 3 and 6-month follow-ups. The CBT treatment focused on behavioral interventions and stress management with a focus on headaches, while the cognitive processing therapy treatment focused on PTSD symptoms. The assessments administered to measure the efficacy of the therapies included self-reports of headache and PTSD symptoms. Statistical analyses were used to determine the effect of each treatment on the alleviation of headache and stress symptoms.
What did they find?
The authors found that CBT treatment significantly improved headaches in veterans. Specifically, those in the CBT group showed significant improvement in both headache symptoms and PTSD symptoms compared to those who received usual care or cognitive processing therapy. Cognitive processing therapy, which focused on the alleviation of PTSD symptoms, did not improve headache disability but did lead to a significant decrease in the severity of PTSD symptoms.
What's the impact?
This study is the first published randomized clinical trial for PTH treatments in veterans. The data show that CBT improved both headache and PTSD symptoms, while cognitive processing therapy only improved the PTSD symptoms. This suggests that cognitive behavioral therapy can be an effective tool for veterans experiencing the ramifications of trauma and brain injuries.