Behavioral Treatments for Post-Traumatic Headache
Purpose of Review
Post-traumatic headache (PTH) is a common headache type after traumatic brain injury (TBI). There are no FDA approved medications for PTH, and it is unknown how medications can affect the brain’s ability to recover from TBI. Thus, we sought to examine the biopsychosocial factors that influence PTH and the non-pharmacologic treatments studied for headache treatment. We also sought to determine if there is literature examining whether the non-pharmacologic treatments influence the biopsychosocial factors. The non-pharmacologic treatments assessed included cognitive behavioral therapy (CBT), biofeedback, progressive muscle relaxation therapy (PMR), acupuncture, and physical therapy (PT).
Factors associated with prognosis in PTH may include the following: severity of TBI, stress, post-traumatic stress disorder, other psychiatric comorbidities, sociocultural and psychosocial factors, litigation, base rate misattribution, expectation as etiology, and chronic pain. There are few high quality studies on the non-pharmacologic treatments for PTH. Thermal and EMG biofeedback appear to have been examined the most followed by CBT. Studies did not have secondary outcomes examining the psychosocial factors related to PTH.
Most of the behavioral studies involved a multi-modality intervention limiting the ability to assess the individual non-pharmacologic interventions we sought to study. There were very few randomized clinical trials evaluating the efficacy of non-pharmacologic interventions. Therefore, future research, which considers the noted biopsychosocial factors, is needed in the field to determine if these interventions reduce PTH.
KeywordsPost-traumatic headache Traumatic brain injury Behavioral treatment Cognitive behavioral therapy Biofeedback Relaxation therapy
Compliance with Ethical Standards
Conflict of Interest
Felicia Fraser, Yuka Matsuzawa, and Yuen Shan Christine Lee declare that they have no conflict of interest.
Mia Minen declares grant funding from NYU School of Medicine Department of Neurology. Dr. Minen is an Empire Clinical Research Investigator Program (ECRIP) Fellow. Her department has received funding for her time to do research related to Post-traumatic headache.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of Particular Interest, Published recently, Have Been Highlighted as: • of Importance •• of Major Importance
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