Randomized Clinical Trial of Cognitive-Behavioral Therapy for Posttraumatic Headache

Dec 10, 2015

More than 100,000 military service members and veterans suffer from chronic headaches resulting from a traumatic brain injury (TBI) sustained during deployment. Although that population has seen a sharp increase in these posttraumatic headaches (PTHA), the condition is extraordinarily difficult to treat. There is very little evidence guiding its management.

Complicating things is the fact that those who have suffered a traumatic injury during deployment often have co-occurring symptoms of posttraumatic stress, which may worsen their headaches or make them more difficult to treat.

To better inform our understanding of how to help our suffering war veterans, principal investigator Donald McGeary of the University of Texas Health Science Center at San Antonio and co-principal investigator Donald Penzien of Wake Forest University have developed a study for the Consortium to Alleviate PTSD (CAP) addressing posttraumatic headache in war veterans with co-occurring symptoms of posttraumatic stress.

A key aim of the study will be to evaluate whether a leading psychological therapy for migraine headaches is effective with posttraumatic headaches. Investigators also seek to determine if treatment for PTHA likewise improves problems with PTSD, and whether treatment for PTSD simultaneously alleviates headaches.

To accomplish these aims, the study will have three arms, with participants placed randomly into one of three treatment conditions:

  • Treatment as usual, receiving standard care for PTHA through the South Texas Veterans Health Care System’s Polytrauma Rehabilitation Center in San Antonio;
  • A gold standard, manualized cognitive-behavioral intervention for headache; or
  • A gold-standard treatment for PTSD, called Cognitive Processing Therapy.

Expected benefit

Because posttraumatic headache is the most common and debilitating chronic symptom of deployment-related traumatic brain injury, this study, if successful, could lead to improved treatment for the more than 100,000 active military and veterans with chronic PTHA. That would mean relief for a variety of problems, including poor general health, missed work days, increased frequency of medical visits, and other physical and mental health symptoms. Cognitive behavioral therapy also costs considerably less to provide than other TBI treatments.

If the proposed study is successful and its hypotheses hold true, it will provide the first scientific evidence supporting the efficacy of any therapy—pharmacological or psychological—in directly treating posttraumatic headache. Consequently, it would offer clinicians and the service members and veterans they treat a safe, effective, medication-free intervention that specifically targets posttraumatic headache symptoms without risk of negative side effects. Cognitive-behavioral treatment could relieve wounded warriors’ suffering from a chronic and often debilitating condition in as little as 6 weeks, facilitating their rapid return to home and work activities and greatly enhancing their quality of life.

For the Defense Department, the dissemination of CBT for posttraumatic headache could potentially save millions of dollars in lost work time while ensuring its primary goals: the rapid care of affected service members and the continued strength of the military’s mission. The therapy’s relatively short duration and its lack of negative side effects enable its use in theater.