Behavioral treatment for post-traumatic headache after mild traumatic brain injury: Rationale and case series

Headache is among the most common persistent symptoms after mild traumatic brain injury (mTBI). Currently available treatments have limited efficacy.

To present a rationale for a novel behavioral treatment approach and a supporting case series with a multiple baseline design.

Pervasive avoidance of common headache triggers may be maladaptive, promoting sensitization and restricting life participation. Graded exposure to triggers that are prone to sensitization (e.g., stress, light flicker, loud noise) may represent an alternative behavioral approach to treating chronic headaches after mTBI. The present study reports on a series of physician-referred patients (N = 4, aged 28-48, enrolled at 9-19 months post-injury) with persistent headache attributed to mTBI. They participated in an 8-session manualized treatment with a registered psychologist. Patients completed a daily headache diary before, during, and after treatment, as well as pre- and post-treatment assessments with a battery of questionnaires.

All patients finished treatment and no adverse events were reported. Improvement was variable across measures of headache frequency/intensity, headache trigger avoidance, post-concussion symptoms, disability, and patient global impression of change.

Future directions for behavioral management of headache triggers as a potential treatment for chronic post-traumatic headaches after mTBI are discussed.