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Cognitive Behavioral Therapy for Veterans With Comorbid Posttraumatic Headache and Posttraumatic Stress Disorder Symptoms: A Randomized Clinical Trial.

Publication ,  Journal Article
McGeary, DD; Resick, PA; Penzien, DB; McGeary, CA; Houle, TT; Eapen, BC; Jaramillo, CA; Nabity, PS; Reed, DE; Moring, JC; Bira, LM; Hansen, HR ...
Published in: Jama Neurol
August 1, 2022

IMPORTANCE: Posttraumatic headache is the most disabling complication of mild traumatic brain injury. Posttraumatic stress disorder (PTSD) symptoms are often comorbid with posttraumatic headache, and there are no established treatments for this comorbidity. OBJECTIVE: To compare cognitive behavioral therapies (CBTs) for headache and PTSD with treatment per usual (TPU) for posttraumatic headache attributable to mild traumatic brain injury. DESIGN, SETTING, AND PARTICIPANTS: This was a single-site, 3-parallel group, randomized clinical trial with outcomes at posttreatment, 3-month follow-up, and 6-month follow-up. Participants were enrolled from May 1, 2015, through May 30, 2019; data collection ended on October 10, 2019. Post-9/11 US combat veterans from multiple trauma centers were included in the study. Veterans had comorbid posttraumatic headache and PTSD symptoms. Data were analyzed from January 20, 2020, to February 2, 2022. INTERVENTIONS: Patients were randomly assigned to 8 sessions of CBT for headache, 12 sessions of cognitive processing therapy for PTSD, or treatment per usual for headache. MAIN OUTCOMES AND MEASURES: Co-primary outcomes were headache-related disability on the 6-Item Headache Impact Test (HIT-6) and PTSD symptom severity on the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PCL-5) assessed from treatment completion to 6 months posttreatment. RESULTS: A total of 193 post-9/11 combat veterans (mean [SD] age, 39.7 [8.4] years; 167 male veterans [87%]) were included in the study and reported severe baseline headache-related disability (mean [SD] HIT-6 score, 65.8 [5.6] points) and severe PTSD symptoms (mean [SD] PCL-5 score, 48.4 [14.2] points). For the HIT-6, compared with usual care, patients receiving CBT for headache reported -3.4 (95% CI, -5.4 to -1.4; P < .01) points lower, and patients receiving cognitive processing therapy reported -1.4 (95% CI, -3.7 to 0.8; P = .21) points lower across aggregated posttreatment measurements. For the PCL-5, compared with usual care, patients receiving CBT for headache reported -6.5 (95% CI, -12.7 to -0.3; P = .04) points lower, and patients receiving cognitive processing therapy reported -8.9 (95% CI, -15.9 to -1.9; P = .01) points lower across aggregated posttreatment measurements. Adverse events were minimal and similar across treatment groups. CONCLUSIONS AND RELEVANCE: This randomized clinical trial demonstrated that CBT for headache was efficacious for disability associated with posttraumatic headache in veterans and provided clinically significant improvement in PTSD symptom severity. Cognitive processing therapy was efficacious for PTSD symptoms but not for headache disability. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02419131.

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Published In

Jama Neurol

DOI

EISSN

2168-6157

Publication Date

August 1, 2022

Volume

79

Issue

8

Start / End Page

746 / 757

Location

United States

Related Subject Headings

  • Veterans
  • Treatment Outcome
  • Stress Disorders, Post-Traumatic
  • Male
  • Humans
  • Headache
  • Comorbidity
  • Cognitive Behavioral Therapy
  • Brain Concussion
  • Adult
 

Citation

APA
Chicago
ICMJE
MLA
NLM
McGeary, D. D., Resick, P. A., Penzien, D. B., McGeary, C. A., Houle, T. T., Eapen, B. C., … Peterson, A. L. (2022). Cognitive Behavioral Therapy for Veterans With Comorbid Posttraumatic Headache and Posttraumatic Stress Disorder Symptoms: A Randomized Clinical Trial. Jama Neurol, 79(8), 746–757. https://doi.org/10.1001/jamaneurol.2022.1567
McGeary, Donald D., Patricia A. Resick, Donald B. Penzien, Cindy A. McGeary, Timothy T. Houle, Blessen C. Eapen, Carlos A. Jaramillo, et al. “Cognitive Behavioral Therapy for Veterans With Comorbid Posttraumatic Headache and Posttraumatic Stress Disorder Symptoms: A Randomized Clinical Trial.Jama Neurol 79, no. 8 (August 1, 2022): 746–57. https://doi.org/10.1001/jamaneurol.2022.1567.
McGeary DD, Resick PA, Penzien DB, McGeary CA, Houle TT, Eapen BC, et al. Cognitive Behavioral Therapy for Veterans With Comorbid Posttraumatic Headache and Posttraumatic Stress Disorder Symptoms: A Randomized Clinical Trial. Jama Neurol. 2022 Aug 1;79(8):746–57.
McGeary, Donald D., et al. “Cognitive Behavioral Therapy for Veterans With Comorbid Posttraumatic Headache and Posttraumatic Stress Disorder Symptoms: A Randomized Clinical Trial.Jama Neurol, vol. 79, no. 8, Aug. 2022, pp. 746–57. Pubmed, doi:10.1001/jamaneurol.2022.1567.
McGeary DD, Resick PA, Penzien DB, McGeary CA, Houle TT, Eapen BC, Jaramillo CA, Nabity PS, Reed DE, Moring JC, Bira LM, Hansen HR, Young-McCaughan S, Cobos BA, Mintz J, Keane TM, Peterson AL. Cognitive Behavioral Therapy for Veterans With Comorbid Posttraumatic Headache and Posttraumatic Stress Disorder Symptoms: A Randomized Clinical Trial. Jama Neurol. 2022 Aug 1;79(8):746–757.

Published In

Jama Neurol

DOI

EISSN

2168-6157

Publication Date

August 1, 2022

Volume

79

Issue

8

Start / End Page

746 / 757

Location

United States

Related Subject Headings

  • Veterans
  • Treatment Outcome
  • Stress Disorders, Post-Traumatic
  • Male
  • Humans
  • Headache
  • Comorbidity
  • Cognitive Behavioral Therapy
  • Brain Concussion
  • Adult