Commentary—Could Prazosin Play a Role in Treating Chronic Posttraumatic Headache?

Clinical experience has shown that there is wide response variability to acute and chronic medication for migraine. Genetic studies of patients with migraine, though at an early stage, have identified genes involved with vascular and neuronal function. It is likely that clinical observation will be borne out by individual responses to drug classes based on individual genetic profiles, so that subtypes of patients in clinical trial populations may show efficacy based on these profiles. It is likely that prazosin will be useful in certain patient subtypes for the treatment of headache. Posttraumatic headache, which may share some similar pathways of headache physiology with primary headache disorders, adds another layer of response complexity.

—Sylvia Lucas, MD, PhD
Clinical Professor of Neurology and Neurological Surgery
University of Washington
Seattle

Suggested Reading

Nampiaparampil DE. Prevalence of chronic pain after traumatic brain injury: a systematic review. JAMA. 2008;300(6):711-719.

Peterlin BL, Nijjar SS, Tietjen GE. Post-traumatic stress disorder and migraine: epidemiology, sex differences, and potential mechanisms. Headache. 2011;51(6):860-868.

Ruff RL, Riechers RG, Wang XF, et al. For veterans with mild traumatic brain injury, improved posttraumatic stress disorder severity and sleep correlated with symptomatic improvement. J Rehabil Res Dev . 2012;49(9):1305-1320.