Newly developed therapy “CBT for headache” benefits veterans with post-traumatic headaches and PTSD

Therapies & Diagnostic Tools Under Research

Nov 20

a healthcare provider sits with their hands holding a notebook and pen, a military service member sits on a couch across from them

By Fadhil Hussain. This article was initially published in our Concussion Update newsletter; please consider subscribing.

Military personnel are more likely to experience post-traumatic stress disorder (PTSD) and mild traumatic brain injuries (mTBI) than the general population. mTBI can often lead to persistent symptoms such as post-traumatic headaches (PTH). A study published in JAMA Neurology aimed to find out whether cognitive behavioral therapy (CBT) could be a viable option for veterans suffering from severe levels of both PTSD and PTH. The study found that a new therapy, CBT for headache, reduced how much these veterans were affected by headaches and PTSD when compared to the usual treatment and that the treatment effect lasted up to 6 months after the therapy.

A press release by UT Health San Antonio quotes the principal investigator, Donald McGeary, Ph.D.: “To find the first major treatment success for post-traumatic headache, which is arguably the most debilitating symptom of TBI, and that the treatment also significantly reduces comorbid PTSD symptoms, is a major breakthrough.” Dr. McGeary’s team developed CBT for headache by modifying “a psychotherapy for migraine headaches.”

In this randomized controlled trial, McGeary et al. explored the effects of two therapies based on cognitive behavioral therapy frameworks on 193 current or former members of the military reporting “severe baseline headache-related disability” and severe PTSD symptoms. The first therapy, cognitive behavioral therapy (CBT) for headache, involved eight one-hour sessions over six weeks “focused exclusively on headache and stress, relying heavily on behavioral interventions and stress management with some cognitive therapy.” The second therapy, Cognitive Processing Therapy (CPT), involved 12 one-hour sessions over six weeks “focused exclusively on PTSD, emphasizing cognitive therapy.” The study also included a control group that received treatment per usual (TPU). Participants completed an assessment of headache-related disability (HIT-6) and an assessment of PTSD symptoms (PCL-5) at four-time points: pre-treatment, post-treatment, and 3- and 6-month follow-ups.

The group receiving CBT for headache had significantly lower scores for headache-related difficulties and PTSD symptoms compared to the usual treatment group up to 6 months after the treatment. The group receiving CPT had significantly lower PTSD symptom scores than the standard treatment group up to 3 months after treatment. Still, the effect was not statistically significant at the 6-month follow-up visit.

There are currently no “frontline treatments” for PTH stemming from mTBI. The result of this study suggests that a nonpharmacological intervention, CBT for headace, could be a viable option to help military members who suffer from post-traumatic headaches and PTSD.