Cognitive therapy shows promise in the treatment of PTSD, headache

  • Researchers examined the efficacy of cognitive behavioral therapy (CBT) for headaches in the treatment of post-traumatic headaches.
  • They found that CBT effectively reduces 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 about 40% of people with post-traumatic headaches also have post-traumatic stress disorder (PTSD).

Post-traumatic headaches are notoriously difficult to treat. Unlike migraine headaches, which have more defined symptoms, it has no clear symptom pattern and is defined by the cause of the headache – trauma.

There are currently no confirmed first-line treatments for post-traumatic headache of mild TBI. Both pharmaceutical and behavioral therapies are largely ineffective.

New treatment strategies for PTH from mild TBI may improve quality of life for veterans and others living with the condition.

Recently, researchers examined two non-pharmacological interventions for post-traumatic headaches – cognitive behavioral therapy (CBT) and cognitive processing therapy (CPT).

They found that CBT for headaches was more effective than usual care in reducing disability associated with post-traumatic headaches and had a significant impact on the severity of PTSD symptoms in veterans. Meanwhile, CPT failed to improve headache disability despite a significant reduction in the severity of PTSD symptoms.

Researchers published the findings in JAMA Neurology

For the study, the researchers recruited 193 post-9/11 war veterans. Their mean age was 39.7 years and 87% were male.

The participants were divided into three groups: one who received CBT for headaches, another who received CPT and the last group – treatment per usual (TPU). The treatments lasted six weeks.

The CBT focused on alleviating the disabilities and stress associated with the headaches through relaxation, setting goals for activities patients wanted to resume, and planning for situations.

Meanwhile, CPT focused on addressing PTSD through strategies to evaluate and change distressing maladaptive thoughts related to trauma.

TPU varied and consisted of:

  • pharmacotherapies
  • pain relief, including Botox injection
  • physiotherapy
  • integrative health treatments, including massage and acupuncture

Headache-related disability was measured with 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 scored 66.1 and TPU participants scored 65.2 points.

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 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 points and the TPU group scored 49. Scores of 31-33 or higher indicate PTSD and the maximum score is 80.

After analyzing the data, the researchers found that the HIT-6 scores for those in the CPT group were reduced by an average of 3.4 points compared to those who received usual care. This improvement in headache-related disability persisted for 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 effect persisting for 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 dropped an average of 8.9 points after treatment compared to those who received usual care.

Analysis of the disaggregated scores showed that usual care resulted in minimal change in headache-related disability — less than one unit change in the 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 authors of the investigation, told MNT

“I believe [CBT for headaches] was effective in this study because we purposefully developed a treatment that would be very broad (ie address as many headache mechanisms as possible) and target function. When people with any kind of pain are able to overcome their disability and engage in more meaningful activities in their lives, pain becomes easier to manage. That was certainly the case 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 intense and does not involve trauma that patients may want to avoid.

The researchers concluded that CBT for headache effectively treats post-traumatic headache of mild TBI and PTSD in veterans.

When asked what these findings mean for the treatment of PTSD and its symptoms, Dr. McGeary said CBT can reduce treatment costs for PTSD and increase access to treatment, as psychologists only require two hours of training and care only lasts 4-8 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 to the gold standard treatment,” he noted.

He added that because of the simplicity of CBT, it can also be effective in children and adolescents; however, they need to test this first.

Shannon Wiltsey Stirman, Ph.D., an associate professor in the Department of Psychiatry and Behavioral Sciences at Stanford University, not involved in the study, told MNT that the therapy may also work in other demographics.

dr. Stirman noted that the therapy could help people who have experienced intimate partner violence or who are reluctant or unable to participate in trauma-focused therapy due to medical problems by providing tools to manage aspects of daily life and PTSD symptoms. to master.

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