“In this population at baseline, 20% were using an acute medication that provided adequate relief,” said Dr. Erickson. “With our treatments, we got that up to 64%.” About 79% of soldiers who were given a triptan reported having adequate two-hour headache relief, compared with 29% who were taking a nontriptan. “This provides evidence that triptans are effective in this population,” he added. “It also helps support the idea that in many of these [cases], the headache itself is a migraine or something very similar to a migraine.”
The response to prophylactic therapies for posttraumatic headache has been “disappointing,” however, said Dr. Erickson. “We don’t seem to have a robust response in terms of headache frequency in the short term,” he commented. “In comparison, if you look at patients with nontraumatic migraine in our clinic, we get a pretty robust response with the initial prophylactic agent. Likewise, patients with nontraumatic migraine who have PTSD also seem to have a pretty good response to prophylactic therapy. So traumatic migraine doesn’t seem to respond the same as nontraumatic migraine. Disability scores do decrease between baseline and follow-up, and I think this is largely related to the effectiveness of acute medications. The triptan is effective, so [soldiers] are less disabled from their headache attacks. If we were able to reduce headache frequency, then I would expect their disability to drop even further.
“Trying to treat their headache in isolation is not going to be as successful as trying to identify all of the problems that are contributing to it,” he continued. “It is important to follow these patients maybe a little bit more closely than you would a typical migraine patient, knowing that the response to prophylactic therapies is not quite as robust. I believe that these patients are going to need more adjustments of their treatment. Finally, I think patient education and expectations for recovery are key in this population.”
—Colby Stong