Nonpharmacologic treatment was effective in improving posttraumatic headache resulting from mild traumatic brain injury (TBI) in veterans, according to a study presented at the 65^th Annual Meeting of the American Headache Society (AHS). Cognitive behavioral therapy (CBT) provided clinically significant improvement in posttraumatic stress disorder (PTSD) symptoms, and it also was beneficial for posttraumatic headache-associated disability. Cognitive processing therapy (CPT) also effectively treated PTSD symptoms, but not headache-associated disability.

The study was a single-site, 3-parallel-arm, randomized clinical trial including 193 veterans with posttraumatic headache attributed to mild TBI who had a mean age of 39.7 years and were 87% male. Participants were randomized to receive either 12, 1-hour sessions of CPT for PTSD, 8, 1-hour sessions of CBT for headache, or treatment as usual for headache. Primary outcomes included PTSD symptom severity according to the PTSD Checklist of the DSM-5 (PCL-5) and headache-related disability according to the 6-Item Headache Impact Test (HIT-6). Outcomes were assessed at posttreatment, 3-month follow-up, and 6-month follow-up.

Compared to usual care for headache, patients receiving CBT scored -3.4 points lower (95% CI, -5.4 to -1.4; P<.01) on the HIT-6, whereas patients receiving CPT scored -1.4 points lower (95% CI, -3.7 to 0.8; P=.21). For PTSD symptoms, patients receiving CBT scored -6.5 points lower (95% CI, -12.7 to -0.3; P=.04) on the PCL-5 compared to treatment as usual, whereas patients receiving CPT scored -8.9 points lower (95% CI, -15.9 to -1.9; P=.01).

The study authors are from the University of Texas Health Science Center San Antonio, the South Texas Veterans Health Care System, the University of Texas at San Antonio, Wake Forest University, Massachusetts General Hospital, the Greater Los Angeles Health Care System, the University of California Los Angeles, the National Center for PTSD, the VA Boston Healthcare System, and the Boston University School of Medicine.