New therapy reduces disability from post-traumatic headache

New therapy reduces disability from post-traumatic headache

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PARIS, July 11 (Benin News) –

The first therapy developed specifically for post-traumatic headaches has significantly reduced post-traumatic headache-related disability in veterans with traumatic brain injury (TBI). It also reduced co-occurring symptoms of post-traumatic stress disorder (PTSD) in a manner comparable to standard treatment, the researchers reported in JAMA Neurology.

In addition, the innovative treatment, Cognitive Behavioral Therapy for Headaches (CBTHD), has proven attractive to patients because it has a low dropout rate, and is easy for therapists to learn and apply, which increases its potential for widespread dissemination and improves the lives of hundreds of thousands of service members and veterans.

This work was conducted by a team of researchers led by Don McGeary, PhD, from the University of Texas Health Science Center at San Antonio (UT Health San Antonio) in the United States and is part of the work of the PTSD Relief Consortium. , a group funded jointly by the Departments of Defense and Veterans Affairs.

“We are delighted with this advancement in the treatment of post-traumatic headache pain, which, like traumatic brain injury, is poorly understood and for which treatment options are very limited,” says Dr. McGeary, associate professor of psychiatry and human sciences. at the Joe R. and Teresa Lozano Long School of Medicine. Finding the first major success in treating post-traumatic headache, arguably the most debilitating symptom of TBI, and that the treatment also significantly reduced comorbid symptoms of PTSD is a breakthrough.

Both TBI and PTSD are hallmark injuries of post-9/11 military conflict, and the two conditions are often associated. Post-traumatic headaches, or headaches that develop or worsen after a head or neck injury, become chronic and debilitating in a large percentage of people who have sustained a head injury, such as a concussion, that prevents them from performing activities of daily living. . When PTSD coexists, it can make headaches worse and more difficult to treat.

There are effective treatments for PTSD, but not for post-traumatic headache, which scientists are still trying to understand, just like TBI. Migraine medications commonly used to relieve headache pain do not relieve headache-related disability. In addition, they often have unwanted side effects, and overuse can make headaches worse.

Dr. McGeary explains the current theory that PTSD may be a “driver” for post-traumatic headaches and the disability they cause. Therefore, the research team wanted to study both the interaction of the pathologies and their treatment and find an effective therapy for both.

The team developed TCDC by modifying a psychotherapy for migraines. In this study, they evaluated its effectiveness on the concomitant symptoms of post-traumatic headache and PTSD.

The study was conducted at the South Texas Veterans Health System Polytrauma Rehabilitation Center. Participants had clinically significant PTSD symptoms and headaches that persisted for more than three months after TBI. They were randomly assigned to receive TCPD, a cutting-edge treatment for PTSD called cognitive processing therapy (CPT), or usual care at the VA polytrauma center.

CBCT, which uses cognitive behavioral therapy concepts to reduce headache-related disability and improve mood, includes key components such as relaxation, goal setting for activities patients want to resume, and planning for these situations.

CPT is a cutting-edge psychotherapy for PTSD that teaches patients to assess and modify disruptive and maladaptive thoughts related to their trauma, with the idea that by changing their thoughts, they can change the way they feel.

À l’issue du traitement, les chercheurs ont verified that, for rapport aux soins habituels, les people ayant benefited from the CTPD ont fait état d’a significant reduction du handicap et de l’impact négatif sur le fonctionnement et la qualité de la daily life. They also showed improvement in PTSD symptoms comparable to that in the group receiving CCT. All of these improvements were maintained six months after treatment ended.

Physiotherapy, on the other hand, produced significant and long-lasting improvements in PTSD symptoms, but by itself did not improve headache-related disability. It was a surprise,” admits Mr. McGeary. If the theories about PTSD causing post-traumatic headaches are correct, one would expect physical therapy to help both PTSD and headaches. Our results cast doubt on this assumption.

Interestingly, CBCT did not reduce headache intensity or frequency compared to usual care. Mr. McGeary believes that the dramatic reduction in negative impact on life is likely because the treatment strengthens patients’ confidence in their ability to control or manage their headaches, a concept known as “self-efficacy.” This sense of control was essential in helping patients “get their lives back.”

“If you can improve a person’s belief that they can control their headache, that works better,” says Dr. McGeary. In fact, when it comes to long-term disabling pain, people decide whether to actively participate in some activity, especially if that activity exacerbates the pain. They make these decisions based on their perceived ability to manage their pain,” he adds.

When it comes to PTSD symptom relief, Dr. McGeary says it’s surprising that CBCT and CPT are comparable. He thinks CBCT was more attractive to patients, so fewer dropped out and more received a full dose of treatment. CDCT requires fewer and shorter therapy sessions, typically eight sessions of 30 to 45 minutes each. CPT is a more demanding therapy and generally requires 12 sessions of 60 to 90 minutes each.

Another advantage of CBCT is that it takes only two hours to train clinicians to apply the therapy, compared to CPT, a complex treatment that requires extensive training and learned skills. This would make it relatively easy to increase the number of therapists available to treat veterans with post-traumatic headaches and ease the workload on clinics.

Following their success with San Antonio veterans, Dr. McGeary and colleagues are trying to replicate their findings in a more diverse sample.

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