Study Suggests Cognitive Therapy May Improve Posttraumatic Headaches

Sarasota, FL (WorkersCompensation.com) – Compared to the general public, military personnel are at a greater risk of head injury. According to data from The Defense Health Agency, there were 18,491 service members diagnosed with traumatic brain injuries in 2021. Of those, 84.5 percent were classified as mild, 14.8 percent were moderate, .3 percent were severe. Broken out by service, Army service members had 4 times as many head injuries as other branches of service with 10,682 brain injuries, of which 17 were severe.

Some studies show those individuals with a traumatic brain injury will report either onset or worsening of headaches within 3 months after injury, with service members even more likely to develop posttraumatic headache. Posttraumatic stress disorder (PTSD) is common with traumatic brain injuries, increasing the likelihood of posttraumatic headaches (PTH).

While treatment for posttraumatic stress and traumatic brain injuries are well documented, the makeup and treatment of PTH due to mild traumatic brain injuries is less understood. Research has offered limited insight in treating with medication, however some studies have shown that medication therapy fails in 79 percent of patients. Cognitive therapy is a potential alternative to treating PTH as it addresses the stress component, however studies showing effectiveness are extremely limited.

Researchers from the Department of Psychiatry and Behavioral Sciences from the University of Texas Health Science Center in San Antonio asked the question of whether cognitive behavioral therapies could potentially improve headache-related disability in those veterans with both PTH and PTSD.

A total of 193 combat veterans participated in the study, with an average age of 39.7 and 87 percent male. Participants were reviewed prior to treatment, post treatment, and follow-ups at 3 and 6 months.

Cognitive behavioral therapy for headache (CBT) and cognitive processing therapy (CPT) were compared to usual treatment for PTH. CBT occurred in 8 weekly or biweekly sessions for an hour with a psychologist. The CPT treatments occurred in 12 hour long sessions over a period of 6 weeks. Treatment as usual occurred by standard VA treatment which included medication, interventional pain management such as injections, physical therapy, and integrative treatments such as massage and acupuncture.

The Headache Impact Test (HIT-6) was used to assess disability measures. Additionally, researchers reviewed participant’s headache diaries, depression and anxiety levels, as well as sleep quality. In addition to the HIT-6 testing measures, researchers also utilized Diagnostic and Statistical Manual of Mental Disorders (PCL-5) to score mental assessments.

Those under CBT care scored 3.4 points lower than usual care on the HIT-6 test. Those under CPT care scored 1.4 points lower. For mental health assessments under the PCL-5 test, those undergoing CBT treatment scored 6.5 points lower than usual care. The CPT care group scored 8.9 points lower than the usual care group.

Overall, the researchers concluded that the participants showed significant improvement in headache related disability as well as a reduction in PTSD severity with use of the cognitive therapies. However, the researchers noted that while CBT therapy addressed the headache severity with an unexpected side effect of PTSD symptom improvement, CPT therapy only addressed the PTSD symptom severity. The researchers believe there is a need for more studies examining the relationship influences of PTH and PTSD, and the potential impact that both CBT and CPT type therapies may have on that relationship.

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