Lifestyle modifications as therapy for medication refractory post-traumatic headache (PTHA) in the military population of Okinawa.

Traumatic brain injury (TBI) is a common cause of death and disability worldwide. In the United States, 1.7 million Americans experience TBI each year, and 40% will experience chronic pain from headaches as a result of their injuries. Post-traumatic headache (PTHA) develops within one week of a head injury, and it is considered chronic when it persists for three or more months.

American service members, who are at particularly high risk for sustaining TBI during deployment, report high rates of PHTA; by some estimates, nearly 20% of service members experience chronic daily headaches, while 78% experience episodic headaches. The psychosocial stressors related to military service can further exacerbate these conditions, making recovery more difficult. As a result, researchers are invested in discovering treatment options for PHTA in order to lessen the enormous burden of TBI-related disability on American service members.

A recent study of service members with TBI identified a number of risk factors for PTHA, including stressful life events, sleep disturbances, and overuse of medication. To target these risk factors, researchers designed a therapeutic treatment plan including cognitive-behavioral strategies, lifestyle coaching, and relaxation therapy. The researchers collected data from 221 patients who were treated for migraines at the Naval Okinawa Neurology Clinic, 22 of whom were active duty service members who had sustained a TBI. Over the course of a year, these 22 service members took part in the cognitive-behavioral therapy intervention, and the researchers found that:

  • Before treatment, one-third of service members with TBI experienced PTHA as a result of their injuries, and two-thirds also suffered from other psychiatric disorders, such as depression, anxiety, or PTSD.
  • After completing a year of cognitive-behavioral therapy, lifestyle coaching, and meditation exercises, there was a 36% decrease in frequency of headaches and a 56% decrease in the severity of headaches.
  • Sixty percent of service members reported a higher quality of life after completing the treatment plan.
  • The Naval Okinawa Neurology Clinic saw a 250% decrease in appointments made for migraines and headaches.

Military populations are at high risk of sustaining TBI, and lifestyle stressors related to service can further complicate the recovery process. Fortunately, targeted interventions designed to promote healthy lifestyle choices and relaxation can improve quality of life and reduce disability among service members. When combined with medication, these interventions are a promising tool for treating military populations who have sustained TBI during their service.

Baker VB, Eliasen KM, &Hack NK. Lifestyle modifications as therapy for medication refractory post-traumatic headache (PTHA) in the military population of Okinawa. The Journal of Headache and Pain. (October 2018).


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