Cognitive Behavioral Therapy for Veterans With Comorbid Posttraumatic Headache and Posttraumatic Stress Disorder Symptoms

McGeary, Donald D.; Resick, Patricia A.; Penzien, Donald; McGeary, Cindy A.; Houle, Timothy T.; Eapen, Blessen C.; Nabity, Paul S; Reed, David E.; Moring, John C.; Bira, Lindsay; Hansen, Hunter; Young‐McCaughan, Stacey; Cobos, Briana; Mintz, Jim; Keane, Terence M.; Peterson, Alan L.

doi:10.1001/jamaneurol.2022.1567

Cited by 23 publications

(22 citation statements)

References 71 publications

(103 reference statements)

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“…Traumatic brain injury, with >50 million cases per year, is a dominant cause of disability in young adults [ 371 , 372 , 373 ], many of whom will have children later. The pathophysiology of TBI involves excessive dysregulation of stress response systems, neuroinflammation, and cognitive decline [ 366 , 368 , 369 , 372 , 373 , 374 , 375 , 376 , 377 , 378 , 379 , 380 , 381 ]. Patients with a history of TBI frequently require general anesthesia/surgery or sedation to treat conditions unrelated to TBI or injuries that may occur at the time of TBI.…”

Section: Pathogenesis Of Pndmentioning

confidence: 99%

Intergenerational Perioperative Neurocognitive Disorder

Morey

Seubert

et al. 2023

Biology

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Accelerated neurocognitive decline after general anesthesia/surgery, also known as perioperative neurocognitive disorder (PND), is a widely recognized public health problem that may affect millions of patients each year. Advanced age, with its increasing prevalence of heightened stress, inflammation, and neurodegenerative alterations, is a consistent contributing factor to the development of PND. Although a strong homeostatic reserve in young adults makes them more resilient to PND, animal data suggest that young adults with pathophysiological conditions characterized by excessive stress and inflammation may be vulnerable to PND, and this altered phenotype may be passed to future offspring (intergenerational PND). The purpose of this narrative review of data in the literature and the authors’ own experimental findings in rodents is to draw attention to the possibility of intergenerational PND, a new phenomenon which, if confirmed in humans, may unravel a big new population that may be affected by parental PND. In particular, we discuss the roles of stress, inflammation, and epigenetic alterations in the development of PND. We also discuss experimental findings that demonstrate the effects of surgery, traumatic brain injury, and the general anesthetic sevoflurane that interact to induce persistent dysregulation of the stress response system, inflammation markers, and behavior in young adult male rats and in their future offspring who have neither trauma nor anesthetic exposure (i.e., an animal model of intergenerational PND).

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Section: Pathogenesis Of Pndmentioning

confidence: 99%

Intergenerational Perioperative Neurocognitive Disorder

Morey

Seubert

et al. 2023

Biology

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“…19 Recent evidence showed cognitive-behavioral therapy (CBT) for headache decreases PTH-related disability. 20 CBT self-management of headache emphasizes the uptake of strategies such as relaxation techniques, increasing awareness of headache triggers, cognitive therapy, and problem-solving strategies to improve stress management. Increases in headache management self-efficacy and decreases in headacherelated disability are expected to occur as different headache management skills are learned.…”

Section: The Limited Efficacy Of Pharmacological Interventions Of Pthmentioning

confidence: 99%

“…Complete details on the research methods, participant demographics, and primary outcomes have been previously published. 20,22 Veterans provided written consent and were screened for inclusion in the study by meeting International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria for persistent (lasting >3 months) PTH and criteria for significant symptoms of posttraumatic stress disorder (PTSD). 1,23 The structured diagnostic interview for headache was conducted, along with confirmation by a physician to ensure that criteria were met for persistent headache attributable to mild TBI (ICHD-3 5.…”

Section: Participantsmentioning

confidence: 99%

“…Headache management self‐efficacy is moderately related to primary headache disability 19 . Recent evidence showed cognitive–behavioral therapy (CBT) for headache decreases PTH‐related disability 20 . CBT self‐management of headache emphasizes the uptake of strategies such as relaxation techniques, increasing awareness of headache triggers, cognitive therapy, and problem‐solving strategies to improve stress management.…”

Section: Introductionmentioning

confidence: 99%

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Mechanisms of change in posttraumatic headache–related disability: A mediation model

et al. 2023

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Objective: To explore whether the association between change in headache management self-efficacy and posttraumatic headache-related disability is partially mediated by a change in anxiety symptom severity.Background: Many cognitive-behavioral therapy treatments for headache emphasize stress management, which includes anxiety management strategies; however, little is currently known about mechanisms of change in posttraumatic headache-related disability. Increasing our understanding of mechanisms could lead to improvements in treatments for these debilitating headaches.

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“…McGeary et al [ 28 ] implemented a triple-armed RCT that compared CBT for headache (CBTH), cognitive processing therapy (a PTSD-specific type of CBT) and the usual treatment in the management of military veterans with comorbid PTH and PTSD. After 8 weeks, the group receiving CBTH demonstrated a significant decrease in 6-item headache impact test (HIT-6) scores compared with those receiving the usual treatment, indicating an improvement in headache-related disability and quality of life.…”

Section: Cognitive and Behavioral Modificationmentioning

confidence: 99%

Update on Non-Pharmacological Interventions for Treatment of Post-Traumatic Headache

2022

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Post-traumatic headache (PTH) is the most common sequelae of traumatic brain injury (TBI). Its phenotypic variability, absence of formal evidence-based guidelines for treatment and underdiagnosis have made its management a challenge for clinicians. As a result, treatment of PTH has been mostly empiric. Although analgesics are the most popular drug of choice for PTH, they can present with several adverse effects and fail to address other psychosocial comorbidities associated with TBI. Non-pharmacological interventions thereby offer an intriguing alternative that can provide patients with PTH sustainable and effective care. This review article aims to: (1) provide an update on and describe different non-pharmacological interventions present in the recent literature; (2) provide clinical guidance to providers struggling with the management of patients with PTH; (3) emphasize the need for more high-quality trials examining the effectiveness of non-pharmacological treatments in patients with PTH. This review discusses 21 unique non-pharmacological treatments used for the management of PTH. Current knowledge of non-pharmacological interventions for the treatment of PTH is based on smaller scale studies, highlighting the need for larger randomized controlled trials to help establish formal evidence-based guidelines.

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Cognitive Behavioral Therapy for Veterans With Comorbid Posttraumatic Headache and Posttraumatic Stress Disorder Symptoms

Cited by 23 publications

References 71 publications

Intergenerational Perioperative Neurocognitive Disorder

Intergenerational Perioperative Neurocognitive Disorder

Mechanisms of change in posttraumatic headache–related disability: A mediation model

Update on Non-Pharmacological Interventions for Treatment of Post-Traumatic Headache

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