Behavioral Treatments for Post-Traumatic Headache

Fraser, Felicia; Matsuzawa, Yuka; Lee, Yuen Shan Christine; Minen, Mia T.

doi:10.1007/s11916-017-0624-x

Cited by 31 publications

(22 citation statements)

References 76 publications

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“…In a randomized controlled trial with patients who had chronic daily headaches of various types, LCT resulted in improved headache ratings and reduced medication use in comparison to avoidance coaching and wait-list control groups. The LCT approach may be especially well-suited to persisting PTH following mild TBI [134]. It has been recently shown that patients with persisting PTH after mild TBI identify a similar pattern of triggers as those in primary headache disorders, but perceive mental exertion as a particularly potent headache precipitant that they try to avoid.…”

Section: Behavioral Treatmentmentioning

confidence: 99%

Persistent post-traumatic headache: a migrainous loop or not? The clinical evidence

et al. 2020

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Background: Headache is a common complication of traumatic brain injury. The International Headache Society defines post-traumatic headache as a secondary headache attributed to trauma or injury to the head that develops within seven days following trauma. Acute post-traumatic headache resolves after 3 months, but persistent posttraumatic headache usually lasts much longer and accounts for 4% of all secondary headache disorders. Main body: The clinical features of post-traumatic headache after traumatic brain injury resemble various types of primary headaches and the most frequent are migraine-like or tension-type-like phenotypes. The neuroimaging studies that have compared persistent post-traumatic headache and migraine found different structural and functional brain changes, although migraine and post-traumatic headache may be clinically similar. Therapy of various clinical phenotypes of post-traumatic headache almost entirely mirrors the therapy of the corresponding primary headache and are currently based on expert opinion rather than scientific evidence. Pharmacologic therapies include both abortive and prophylactic agents with prophylaxis targeting comorbidities, especially impaired sleep and post-traumatic disorder. There are also effective options for non-pharmacologic therapy of posttraumatic headache, including cognitive-behavioral approaches, onabotulinum toxin injections, lifestyle considerations, etc. Conclusion: Notwithstanding some phenotypic similarities, persistent post-traumatic headache after traumatic brain injury, is considered a separate phenomenon from migraine but available data is inconclusive. High-quality studies are further required to investigate the pathophysiological mechanisms of this secondary headache, in order to identify new targets for treatment and to prevent disability.

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Section: Behavioral Treatmentmentioning

confidence: 99%

Persistent post-traumatic headache: a migrainous loop or not? The clinical evidence

et al. 2020

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“…Research supports the use of non-pharmacological treatments for persistent PCH [ [3] , [4] , [5] ]. For example, within the Veterans Affairs/ Clinical Practice Guideline (CPG) for the Management of Concussion and mTBI [ 6 ] the use of “education on lifestyle modifications, PT [physical therapy] [and] integrative medicine techniques (e.g., acupuncture, relaxation therapy, mindfulness training)…” (p.30) for treatment of PCH are recommended.…”

Section: Introductionmentioning

confidence: 99%

Strength and awareness in action: Feasibility of a yoga-based intervention for post-acute mild TBI headaches among veterans

Betthauser

Forster

Bortz

et al. 2021

Contemporary Clinical Trials Communications

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Background Mild traumatic brain injury (mTBI) is a signature injury sustained by Veterans during recent conflicts. For some, mTBI/concussion is associated with disabling symptoms, including post-concussive headaches (PCH). However, there are limited evidence-based treatments for persistent PCH. Objective Investigators assessed the feasibility of design elements of a yoga-based interventional trial for PCH among Veterans, as well as the acceptability of the intervention. Methods This randomized controlled acceptability and feasibility trial was implemented using a waitlist-control design. Design elements of interest included: an exercise run-in class; recruitment and retention strategies; and, ecological momentary assessment (EMA) modalities to track headaches and yoga practice. Veteran satisfaction regarding the intervention was also evaluated. A descriptive analysis was conducted on candidate outcomes including PCH, post-concussive symptoms, pain, and daily functioning. Results Twenty-seven participants (out of 70 consented and eligible after Study Visit 1) completed each evaluation timepoint and regularly attended yoga sessions, with 89% of these Veterans reporting moderate to high levels of satisfaction with the intervention at study completion. Qualitatively, participants endorsed improvements in headaches, chronic pain, and mood. Feasibility results were mixed. Initial feasibility criterion regarding yoga attendance was not met; however, modifications, such as expansion to an additional clinic site and reduction of in-person yoga sessions with increased encouragement to use study-created online yoga videos improved feasibility of the study design. Participants most frequently used mobile and web-based EMA modalities to track yoga practice. Conclusions Although challenges with feasibility of the study design elements were noted, results suggested acceptability of the yoga-based intervention for Veterans with persistent PCH. Additional exploration regarding the frequency and modality of yoga delivery (e.g., in-person, telehealth) is warranted. Impact Veterans found the yoga-based intervention acceptable, however exploration of novel modalities of intervention delivery will likely be necessary to enhance the feasibility of intervention implementation during future trials.

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“…Patients with migraine are 2-4 times more likely to develop major depressive disorder [13,14]. It is theorized that environmental stressors, work demands, changing sleep cycles and the frequency of traumatic brain injury magnify the burden of headaches and psychiatric conditions [15][16][17][18]. Furthermore, major depressive disorders and pain syndromes have biological associations with levels of thyroid hormones, prolactin and serotonin.…”

Section: Introductionmentioning

confidence: 99%

Lost productivity associated with headache and depression: a quality improvement project identifying a patient population at risk

2020

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Objective: This quality improvement project was implemented in order to highlight the association between headache, mTBI and depression on lost productivity and resource utilization. Background: Mood disorders, environment and traumatic brain injury are common in patients with headache, and have been shown to influence clinical course, treatment response and outcome. Although widely recognized, the association of these factors on clinical outcomes, resource utilization and productivity is not well understood. Methods: All patients presenting to a military referral center for migraines are assessed for presence of traumatic brain injury, Headache Impact Score (HIT-6) and Patient Depression Questionnaire (PHQ-9). Based on screening, patients are offered referral to mental health and a multidisciplinary headache education course. Results: 237 patients were seen for headache or migraine. 180 patients had severely disabling headaches. These patients accounted for 146 emergency room visits over the course of one year. Of headache patients, 65% met criteria for depression and 15% of patients had severe depression. Only 37% of these patients carried a formal diagnosis of depression and 38% had been seen by mental health. Lost productivity and duty limitations were significantly associated with severity of depression. In service members screening positively for mild, moderate or severe depression, duty restrictions had been placed on 8.3%, 32.5% and 53.8%, respectively. Only 3.8% of patients who did not screen for depression had similar duty limitations. A history of mTBI strongly correlated with comorbid depression. Lost productivity and duty limitations were not impacted by other headache characteristics or HIT-6 scores. Conclusions: This quality improvement project identified a practice gap for treatment of comorbid depression in patients presenting to Neurology for headache. Depression strongly correlated with productivity loss, highlighting a possible target for the economic burden of headache.

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Behavioral Treatments for Post-Traumatic Headache

Cited by 31 publications

References 76 publications

Persistent post-traumatic headache: a migrainous loop or not? The clinical evidence

Persistent post-traumatic headache: a migrainous loop or not? The clinical evidence

Strength and awareness in action: Feasibility of a yoga-based intervention for post-acute mild TBI headaches among veterans

Lost productivity associated with headache and depression: a quality improvement project identifying a patient population at risk

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