- Researchers looked at the effectiveness of cognitive behavioral therapy (CBT) for headaches in treating post-traumatic headaches.
- They found that CBT was effective in reducing disability associated with post-traumatic headaches and symptoms of post-traumatic stress disorder (PTSD) in veterans.
- They say the therapy can also reduce the costs associated with treating these conditions.
Traumatic brain injury (TBI) is a recognized risk of military service. Those who experience TBI are also at risk of developing post-traumatic headaches.
Research suggests that around 40% of people with post-traumatic headaches also have post-traumatic stress disorder (PTSD).
Post-traumatic headache is notoriously difficult to treat. Unlike migraines, which have more defined symptoms, they don’t have a clear symptom pattern and are defined by the cause of the headache – trauma.
There is currently no confirmed first-line treatment for post-traumatic headache caused by mild TBI. Pharmaceutical and behavioral therapies are largely ineffective.
New treatment strategies for PTH due to mild TBI could improve the quality of life for veterans and others with the disease.
Recently, researchers have examined two non-pharmacological interventions for post-traumatic headache – cognitive behavioral therapy (CBT) and cognitive processing therapy (CPT).
They found that CBT for headache was more effective than usual care in reducing disability associated with posttraumatic headaches and had a significant impact on the severity of PTSD symptoms in veterans. Meanwhile, CPT failed to improve headache disability, despite significant reductions in PTSD symptom severity.
The researchers published the results in
For the study, researchers recruited 193 veterans after 9/11. Their average age was 39.7 years and 87% were male.
The participants were divided into three groups: one receiving CBT for headaches, another receiving CPT and the last group – the usual treatment (UPT). The treatments lasted six weeks.
CBT focused on relieving the disability and stress associated with headaches through relaxation, setting goals for activities patients wanted to resume, and planning for situations.
During this time, CPT focused on addressing PTSD through strategies to assess and change upsetting maladaptive thoughts related to trauma.
The TPU varied and consisted of:
- pain management, including Botox injection
- physical therapy
- integrative health treatments including massage and acupuncture
Headache-related disability was measured by the Headache Impact Test 6 (HIT-6). At baseline, participants in the CBT group scored an average of 66.1 points on the HIT-6 scale, while those in the CPT group scored 66.1 and TPU participants scored 65.2.
A score of 60 or more is considered “severe” and the maximum score on the scale is 78.
PTSD was assessed by the PTSD Checklist for the DSM-5 (PCL-5). At baseline, the CBT group scored an average of 47.7 points on the scale, while the CPT group scored 48.6 and the TPU group scored 49. Scores of 31 to 33 or higher indicate PTSD, and the maximum score is 80.
After analyzing the data, the researchers found that the HIT-6 scores of people in the CPT group were reduced by an average of 3.4 points compared to those receiving usual care. This improvement in headache-related disability was maintained six months after treatment.
PTSD scores for the CPT group also decreased by an average of 6.5 points compared to the usual care group immediately after treatment, with treatment effects lasting up to 6 months after treatment.
Meanwhile, those in the CPT group experienced a more modest improvement in headache-related disability, with an average decrease of 1.4 points after treatment compared to those in the TPU group.
PTSD scores in the CPT group decreased by an average of 8.9 points after treatment compared to those receiving usual care.
Analysis of disaggregated scores showed that usual care resulted in minimal change in headache-related disability – less than one unit change in mean HIT-6 score. However, there was a decrease in PTSD score of 6.8 points among those in the usual care group, which further decreased to 7.7 points 6 months later.
When asked what might explain the different effects of CBT and other treatment options, Don McGeary, Ph.D., ABPP, associate professor in the Department of Psychiatry and Behavioral Sciences at the University of Texas Health San Antonio, and one of the study’s authors, told DTM:
“I believe [CBT for headaches] was effective in this study because we deliberately developed a treatment that would be very broad (ie, address as many headache mechanisms as possible) and focus on function. When people with any type of pain are able to overcome their disability and perform more meaningful activities in their lives, then pain becomes more manageable. This was certainly true in our study.
Dr. McGeary added that veterans were more likely to complete CBT than CPT. He noted that this may be because CBT is less intensive and does not involve delving into trauma that patients might want to avoid.
The researchers concluded that CBT for headache effectively treats post-traumatic headaches from mild TBI and PTSD in veterans.
When asked what these results mean for the treatment of PTSD and its symptoms, Dr. McGeary said that CBT could reduce PTSD treatment costs and increase access to treatment because psychologists don’t need only two hours of training and the care lasts only 4 to 8 hours. In comparison, CPT requires rigorous training and more than 12 hours of care.
“We are still working to identify who is likely to benefit and suspect that veterans with less severe PTSD symptoms will benefit from the headache intervention, while those with more severe symptoms should be referred for treatment. benchmark,” he noted.
He added that because of the simplicity of CBT, it could also be effective in children and adolescents; however, they need to test this first.
Shannon Wiltsey Stirman, Ph.D., associate professor in the Department of Psychiatry and Behavioral Sciences at Stanford University, not involved in the study, said DTM that the therapy may also work in other demographic groups.
Dr. Stirman noted that the therapy could benefit people who have experienced domestic violence or who are unwilling or unable to engage in trauma-focused therapy due to medical issues by providing tools to manage aspects of everyday life and PTSD symptoms.