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Improving PTSD Symptoms in Veterans with Mild TBI

This study evaluated veterans with mild traumatic brain injury (mTBI) experiencing PTSD, headaches, and cognitive deficits. Results showed that combining prazosin with sleep hygiene counseling led to decreased headache severity, improved cognitive function, and reduced PTSD symptoms.

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Improving PTSD Symptoms in Veterans with Mild TBI

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  1. For veterans with mild traumatic brain injury, improved posttraumatic stressdisorder severity and sleep correlated with symptomatic improvement Robert L. Ruff, MD, PhD; Ronald G. Riechers II, MD; Xiao-Feng Wang, PhD; Traci Piero, NP‐C, MSN; Suzanne S. Ruff, PhD

  2. Aim • Evaluate 63 veterans with mild traumatic brain injury (mTBI) who also had headache, posttraumatic stress disorder (PTSD), and neurological deficits (NDs). • Determine whether improved headaches and cognitive function were associated with reduced PTSD severity, resolution of NDs, or both. • Relevance • Combat mTBI is often associated with PTSD; impaired sleep; and pain, particularly headaches.

  3. Method • We treated veterans with sleep hygiene counseling and oral prazosin. • At baseline, after 9 wk of sleep counseling and prazosin, and 6 mo after end of treatment, we assessed: • Headache severity. • Daytime sleepiness (Epworth Sleepiness Scale). • Cognitive function (Montreal Cognitive Assessment). • Presence of NDs (including impaired olfaction). • PTSD severity (PTSD Checklist-Military Version).

  4. Results • After 9 wk of sleep counseling and prazosin: • Headache severity decreased. • Cognitive function improved. • Daytime sleepiness diminished. • 6 mo after completing treatment: • Additional improvement in headache severity and daytime sleepiness occurred. • Improved cognitive function persisted. • Prevalence of NDs and olfaction scores didn’t change.

  5. Normalized values of variables at baseline, 9 wk after initiation of sleep hygiene counseling and prazosin treatment, and 6 mo after completion of 9 wk initiation period (final). ESS = Epworth Sleepiness Scale, Freq. = frequency, HA = headache, MOCA = Montreal Cognitive Assessment, OLF = olfaction, PCL-M = Posttraumatic Stress Disorder Checklist-Military Version.

  6. Conclusion • Prazosin combined with sleep hygiene counseling reduced severity of headaches, PTSD, and daytime sleepiness. • Presence of NDs didn’t change. • NDs we observed may only be markers of mild brain damage due to mTBI. • While NDs didn’t drive improved headache symptoms and cognitive scores, mTBI with loss of consciousness may predispose to PTSD.

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