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HomeHealthMedicineCBT May Improve Comorbid Posttraumatic Headache, PTSD

CBT May Improve Comorbid Posttraumatic Headache, PTSD

Cognitive-behavioral therapies (CBTs) can present aid from comorbid, persistent posttraumatic headache and posttraumatic stress disorder (PTSD), new analysis suggests.

Results from a randomized scientific trial of virtually 200 navy veterans confirmed that, in contrast with traditional care, CBT for headache led to important enchancment in each headache incapacity and PTSD signs. Cognitive processing remedy (CPT) additionally led to important enchancment in PTSD signs, but it surely didn’t enhance headache incapacity.

Lead creator Donald McGeary, PhD, Department of Rehabilitation Medicine, the University of Texas Health Science Center at San Antonio, famous the enhancements proven in headache incapacity after CBT have been probably as a consequence of its constructing of sufferers’ confidence that they may management or handle their complications themselves.

That sense of management was key to serving to sufferers “get their lives back. If you can improve a person’s belief that they can control their headache, they function better,” McGeary mentioned in a information launch.

The findings have been published online June 27 in JAMA Neurology.

Signature Wounds

Both mild traumatic brain injury (TBI) and PTSD are signature wounds of post-9/11 navy conflicts. The two circumstances generally happen collectively and might hurt high quality of life and functioning, the investigators be aware. Following gentle TBI, many veterans expertise persistent posttraumatic headache, which frequently co-occurs with PTSD.

To gauge the affect of CBTs for this affected person inhabitants, researchers recruited 193 post-9/11 fight veterans (imply age, 39.7 years) with clinically important PTSD signs and posttraumatic headache that had persevered greater than 3 months after TBI. Of these, 167 have been males.

All members have been receiving care on the Polytrauma Rehabilitation Center of the South Texas Veterans Health Care System in Houston.

They have been randomly allotted to bear eight classes of manualized CBT for headache, 12 classes of manualized CPT for PTSD, or traditional headache therapy.

CBT for headache makes use of CBT ideas to cut back headache incapacity and enhance temper ― and contains key parts, resembling rest, setting objectives for actions sufferers need to resume, and planning for these conditions.

CPT is a number one psychotherapy for PTSD. It teaches sufferers the right way to consider and alter upsetting and maladaptive ideas associated to their trauma. The concept is that, by altering ideas, sufferers can change the best way they really feel.

Treatment as traditional was in keeping with multidisciplinary therapy in a big VA multiple-trauma middle and will embrace pharmacotherapies, bodily and occupational therapies, ache medicines, acupuncture, and therapeutic massage.

The co-primary outcomes have been headache-related incapacity on the six-Item Headache Impact Test (HIT-6) and PTSD symptom severity on the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5), assessed from finish of therapy to six months put up therapy.

At baseline, all members reported extreme headache-related incapacity (imply HIT-6 rating, 65.8 factors) and extreme PTSD signs (imply PCL-5 rating, 48.4 factors).

Significant Improvement

Compared with traditional care, CBT for headache led to important enchancment in headache incapacity (posttreatment imply change in HIT-6 rating, -3.4 factors; P < .01) and PTSD signs (posttreatment change in PCL-5, -6.5 factors; P = .04).

CPT additionally led to important enchancment in PTSD signs (8.9 factors decrease on the PCL-5 after therapy; P = .01), but it surely had solely a modest impact on headache incapacity (1.4 factors decrease after therapy; P = .21).

“This was a surprise,” McGeary mentioned. “If theories about PTSD driving posttraumatic headache are correct, you’d expect CPT to help both PTSD and headache. Our findings call that into question.”

Despite enhancements in headache incapacity, CBT for headache didn’t considerably cut back headache frequency or depth.

The researchers are actually hoping to duplicate their findings in a bigger trial at a number of navy and VA websites across the United States.

“We need more women, more racial and ethnic diversity, veterans as well as active military of different branches with varying comorbidities in different geographic regions attached to different hospitals and medical systems, because we’re comparing to usual care,” McGeary mentioned.

A Step Forward

Commenting for Medscape Medical News, retired Col. Elspeth Cameron Ritchie, MD, chair of psychiatry, MedStar Washington Hospital Center in Washington, DC, mentioned she was “pleased” to see that this research was carried out and that she was happy with the outcomes.

“It’s been 20 years since 9/11, and wars are pretty much forgotten, but people are still suffering from the effects of traumatic brain injury and posttraumatic stress disorder. These are not conditions that go away quickly or lightly. They do take work,” mentioned Ritchie, who was not concerned with the analysis.

Finding therapies moreover treatment which might be useful is “good and is a step forward. The more alternatives we have, the better,” she concluded.

The research was supported partly by the US Department of Defense and the US Department of Veterans Affairs. McGeary and Ritchie have reported no related monetary relationships.

JAMA Neurol. Published June 27, 2022. Full article

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