Improving sleep: Initial headache treatment in OIF/OEF veterans with blast-induced mild traumatic brain injury

Ruff, Robert L.; Ruff, Suzanne; Wang, Xiao Feng

doi:10.1682/jrrd.2009.05.0062

Cited by 102 publications

(90 citation statements)

References 50 publications

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“…This observational study of 74 Iraq War veterans with mild traumatic brain injury and comorbid headaches (71 had PTSD, and only 5 had restful sleep) assessed changes in headache pain, cognition, and sleep. 37 Sleep hygiene counseling and prazosin improved sleep symptoms and Epworth Sleepiness Scale scores in the 60 patients who completed the 9-week intervention of prazosin therapy, up to 7 mg nightly.…”

Section: Other Studiesmentioning

confidence: 92%

Treatment of Nightmares With Prazosin: A Systematic Review

Kung

Espinel

Lapid

2012

Mayo Clinic Proceedings

258

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Nightmares, frequently associated with posttraumatic stress disorder and clinically relevant in today's world of violence, are difficult to treat, with few pharmacologic options. We performed a systematic review to evaluate the evidence for the use of prazosin in the treatment of nightmares. A comprehensive search was performed using the databases EMBASE, Ovid MEDLINE, PubMed, Scopus, Web of Science, and Cochrane Database of Systematic Reviews, from their inception to March 9, 2012, using keywords prazosin and nightmares/PTSD or associated terms (see text). Two authors independently reviewed titles and abstracts and selected relevant studies. Descriptive data and outcomes of interest from eligible studies were extracted by 1 author, and checked by 2 others. The risk of bias of randomized controlled trials (RCTs) was assessed independently by 2 reviewers. Articles met criteria for inclusion if prazosin was used to treat nightmares, and outcome measures included nightmares or related symptoms of sleep disorders. Our search yielded 21 studies, consisting of 4 RCTs, 4 open-label studies, 4 retrospective chart reviews, and 9 single case reports. The prazosin dose ranged from 1 to 16 mg/d. Results were mixed for the 4 RCTs: 3 reported significant improvement in the number of nightmares, and 1 found no reduction in the number of nightmares. Reduced nightmare severity with use of prazosin was consistently reported in the open-label trials, retrospective chart reviews, and single case reports.

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Section: Other Studiesmentioning

confidence: 92%

Treatment of Nightmares With Prazosin: A Systematic Review

Kung

Espinel

Lapid

2012

Mayo Clinic Proceedings

258

View full text Add to dashboard Cite

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“…PTSD is commonly associated with TBI. The VA Cleveland Polytrauma Center conducted a carefully designed observational study with a group of 74 Operation Iraqi Freedom/Operation Enduring Freedom veterans exposed to an explosion in combat, with mild TBI characterized by residual headaches and cognitive deficits (Ruff et al [112]). Of the group, 71 were comorbid for PTSD.…”

Section: Adrenergic Inhibiting Agentsmentioning

confidence: 99%

Treatment of sleep disturbances in posttraumatic stress disorder: A review

Schoenfeld

DeViva²,

Manber³

2012

JRRD

219

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Abstract-Sleep disturbances are among the most commonly reported posttraumatic stress disorder (PTSD) symptoms. It is essential to conduct a careful assessment of the presenting sleep disturbance to select the optimal available treatment. Cognitivebehavioral therapies (CBTs) are at least as effective as pharmacologic treatment in the short-term and more enduring in their beneficial effects. Cognitive-behavioral treatment for insomnia and imagery rehearsal therapy have been developed to specifically treat insomnia and nightmares and offer promise for more effective relief of these very distressing symptoms. Pharmacotherapy continues to be an important treatment choice for PTSD sleep disturbances as an adjunct to CBT, when CBT is ineffective or not available, or when the patient declines CBT. Great need exists for more investigation into the effectiveness of specific pharmacologic agents for PTSD sleep disturbances and the dissemination of the findings to prescribers. The studies of prazosin and the findings of its effectiveness for PTSD sleep disturbance are examples of studies of pharmacologic agents needed in this area. Despite the progress made in developing more specific treatments for sleep disturbances in PTSD, insomnia and nightmares may not fully resolve.

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“…As previously stated [10], this was an observational study of a cohort of U.S. OIF/OEF veterans with combat mTBI associated with an explosion. This study was a Neurology Service Quality Assurance Monitor of the evaluation and treatment of OIF/OEF veterans with mTBI.…”

Section: Subject Selectionmentioning

confidence: 99%

“…In addition, each veteran in the study group had one or more NDs, including impaired olfaction, and PTSD. The subject population in our prior study of the effects of sleep hygiene counseling and prazosin treatment was 74 veterans, all of whom had headaches and an ND or abnormality on neuropsychological testing [10]. The 63 subjects in this study were a subset of those 74 veterans, with the additional requirements that each veteran in this study had PTSD and an ND.…”

Section: Subject Selectionmentioning

confidence: 99%

“…In both Vietnam-era veterans [8] and military personnel deployed in OIF/OEF [9], prazosin improved sleep by reducing nightmares. We found in an observational study that a treatment protocol using prazosin and sleep hygiene counseling reduced the frequency and severity of headaches in a group of U.S. OIF/OEF veterans who had physician-confirmed episodes of mTBI associated with loss of consciousness (LOC) due to explosions in combat [10]. All the veterans had headaches, which they stated developed following mTBI.…”

Section: Introductionmentioning

confidence: 99%

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For veterans with mild traumatic brain injury, improved posttraumatic stress disorder severity and sleep correlated with symptomatic improvement

Ruff

Riechers²,

Wang³

et al. 2012

JRRD

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Abstract-This was an observational study of a cohort of 63 Operation Iraqi Freedom/Operation Enduring Freedom veterans with mild traumatic brain injury (mTBI) associated with an explosion. They had headaches, residual neurological deficits (NDs) on neurological examination, and posttraumatic stress disorder (PTSD) and were seen on average 2.5 years after their last mTBI. We treated them with sleep hygiene counseling and oral prazosin. We monitored headache severity, daytime sleepiness using the Epworth Sleepiness Scale, cognitive performance using the Montreal Cognitive Assessment test, and the presence of NDs. We quantitatively measured olfaction and assessed PTSD severity using the PTSD Checklist-Military Version. Nine weeks after starting sleep counseling and bedtime prazosin, the veterans' headache severity decreased, cognitive function as assayed with a brief screening tool improved, and daytime sleepiness diminished. Six months after completing treatment, the veterans demonstrated additional improvement in headache severity and daytime sleepiness and their improvements in cognitive function persisted. There were no changes in the prevalence of NDs or olfaction scores. Clinical improvements correlated with reduced PTSD severity and daytime sleepiness. The data suggested that reduced clinical manifestations following mTBI correlated with PTSD severity and improvement in sleep, but not the presence of NDs or olfaction impairment.

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Improving sleep: Initial headache treatment in OIF/OEF veterans with blast-induced mild traumatic brain injury

Cited by 102 publications

References 50 publications

Treatment of Nightmares With Prazosin: A Systematic Review

Treatment of Nightmares With Prazosin: A Systematic Review

Treatment of sleep disturbances in posttraumatic stress disorder: A review

For veterans with mild traumatic brain injury, improved posttraumatic stress disorder severity and sleep correlated with symptomatic improvement

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