SEATTLE — While there are few treatment options that currently exist for post-traumatic headaches, new research is offering up hope for those habitually dealing with this form of chronic pain. Scientists at the VA Puget Sound Health Care System have demonstrated that prazosin, a prescription drug for treating hypertension (high blood pressure) also appears capable of preventing post-traumatic headaches.
“Persistent post-traumatic headaches are the most common long-term consequence of mild traumatic brain injuries (concussions) in Veterans and active-duty service members, causing substantial distress and disability at home and work. Although these headaches usually resemble migraine headaches symptomatically, they often fail to respond to the prevention treatments useful for migraines,” says senior study author Dr. Murray Raskind, director of the VA Northwest Mental Illness Research, Education and Clinical Center, in a media release.
Prazosin — commonly available under the brand name Minipress — was originally approved by the U.S. Food and Drug Administration to treat high blood pressure in 1976. Since then, it has widely been used in an “off-label” manner to treat conditions such as PTSD-associated nightmares and enlarged prostate as well. An earlier research project conducted by the team working on this latest study found that prazosin could reduce the frequency and severity of headaches due to traumatic brain injury (TBI).
So, to test this effect further, study authors put together a pilot study consisting of 48 veterans and service members dealing with headaches resulting from mild TBI (concussion). Participants had to take gradually increasing doses of prazosin for five weeks before taking the maximum dose for the next 12 weeks. This approach revealed that the drug was well-tolerated, with researchers reporting morning drowsiness as the only adverse effect.
Before the study began, patients dealt with an average of about 18 headache days per month. By the end of the 12-week period, those taking prazosin only had headaches for an average of six days monthly. Those taking a placebo reported some reduction in headaches, but still had headaches roughly 12 times per month. Significantly more participants in the prazosin group had at least 50 percent fewer headaches during the 12-week span of taking the full dose.
Notably, those taking prazosin also enjoyed significant decreases in how much their headaches impacted their quality of life. By the time the trial ended, patients taking prazosin reported that headaches had “some impact” on their daily ability to function. Meanwhile, participants given a placebo continued to report the “severe impact” of headaches.
All in all, researchers say larger clinical trails are necessary in order to confirm the extent of these promising results. However, these initial results should certainly offer at least some potential relief for a common ailment faced by many veterans.
“This study is the only clinical trial of an oral medication to demonstrate efficacy for post-traumatic headache. Because prazosin is widely used across VA and the Department of Defense to treat PTSD trauma nightmares and sleep disruption, many VA and DOD prescribers are familiar with prescribing this generically available, inexpensive medication,” Dr. Raskind concludes. “Prazosin now offers an evidence-based approach to alleviate the suffering of Veterans and service members who have struggled for years with frequent post-traumatic headaches.”
TBI has been referred to as a “signature injury” tied to the recent wars in Iraq and Afghanistan. Since 2000, over 460,000 service members have sustained a TBI, most of which were mild TBIs. Headaches are very common following a mild TBI, often becoming chronic and causing substantial disability and distress over the long-term.
The study is published in Headache The Journal of Head and Face Pain.
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