Post-traumatic headaches are a common complication of traumatic brain injury (TBI), affecting up to 60% of those who sustain such injuries. A study performed by VA Puget Sound Health Care System researchers found that prazosin, a high blood pressure medication, can help reduce post-traumatic headaches.
Senior study author Dr. Murray Raskind, director of the VA Northwest Mental Illness Research, Education, and Clinical Center in Seattle, Washington, noted that there are few therapy choices for this form of headache.
“Persistent posttraumatic 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,” said Raskind.
Persistent posttraumatic headaches are the most common long-term consequence of mild traumatic brain injuries in Veterans and active-duty service members, causing substantial distress and disability at home and work.
Dr. Murray Raskind
In 1976, the FDA approved prazosin as a treatment for hypertension. It has been commonly used “off-label” to treat illnesses including PTSD-related nightmares and an enlarged prostate. A previous study conducted by members of the research group revealed that prazosin could lower the frequency and intensity of headaches produced by traumatic brain injury.
To investigate this effect, the researchers conducted a pilot study with 48 Veterans and service personnel who had headaches caused by mild TBI, sometimes known as a concussion. Participants got prazosin in steadily increasing doses for five weeks before getting the maximal dose for 12 weeks. The trial found that the medicine was well tolerated, with morning sleepiness being the sole side effect.
Before the trial began, study participants had an average of 18 headache days each month. By the end of the 12 weeks, those taking prazosin only had headaches for an average of six days a month. Participants receiving a placebo reported some reduction in headaches but still had headaches about 12 days a month. Significantly more participants in the prazosin group had at least 50% fewer headaches during the 12 weeks of taking a full dose of medication.
Participants taking prazosin also saw significant decreases in how much headaches impacted their quality of life. By the end of the trial, those taking prazosin reported that headaches had “some impact” on their daily ability to function, while participants given a placebo continued to report “severe impact” of headaches.
Larger clinical trials are needed to confirm the extent of these promising results, according to the researchers, but these initial findings offer a potential relief for a common ailment faced by many Veterans.
“This is the only clinical trial of an oral medication that has shown efficacy for posttraumatic headache.” Because prazosin is frequently used to treat PTSD trauma nightmares and sleep disruption, many VA and DOD prescribers are accustomed to administering this generically available, low-cost medicine,” Raskind explained. “Prazosin now offers an evidence-based approach to alleviate the suffering of Veterans and service members who have struggled for years with frequent posttraumatic headaches.”
TBI has been called the “signature injury” of the recent wars in Iraq and Afghanistan. Since 2000, more than 460,000 service members have sustained a TBI, most of which were mild TBIs. Headaches are common following a mild TBI, and they often become chronic and cause substantial disability and distress.
