Contribution of Psychological Health Comorbidity to Personalized Treatment for Headache Attributable to mTBI
Abstract
Applicability to FY22 TBIPHRP FPA Focus Areas: The present Focused Program Award application will capitalize on advancements in mTBI headache treatment developed through prior NIH and CDMRP-sponsored trials to establish a personalized treatment model for military Service Members and Veterans with headache attributable to mTBI. We plan to leverage retrospective, ongoing, and prospective research in mTBI and headache to isolate patient-centered, geographic, health care system, and treatment-specific factors that predict good versus poor response to specific interventions in this population. Thus, this application will directly address FY22 TBIPHRP Treat Focus Area and Sub-Area 3a, personalized medicine approaches to treatment that include tailoring treatment to biological and endophenotypic elements present. Critical Problem to Be Addressed: Headache is one of the most bothersome and disabling conditions arising from mild traumatic brain injury (mTBI). Despite significant growth in research on these headaches over the past decade, there is surprisingly little known about how to effectively treat them. Headache attributable to mTBI (also known as posttraumatic headache, PTH) is uniquely challenging to assess or treat because the clinical symptoms that accompany them are varied and PTH often presents in the context of trauma-related comorbidities that make patients less responsive to some treatments. PTH is diverse, so attempts to treat it are equally diverse but rarely effective because there is no available information that can be used by patients or their providers to guide which treatment should be used and when. This Focused Program of research was designed to improve our understanding of factors that predict when a PTH headache will occur and patient-centered variables that predict which treatments are likely to help most for which patients. Ultimate Applicability and Impact of the Research: We developed a plan for four independent but mutually beneficial studies that will (1) identify headache symptoms that are most bothersome to patients so we can target our treatment to them, (2) explore factors that predict whether and how well a Veteran or Service Member with PTH will respond to medication or non-medication interventions, and (3) create an interactive headache diary that use information provided by the patient to predict when a headache attack will occur and make treatment recommendations tailored to each individual patient. If successful, this Focused Program would offer the first evidence of factor predicting PTH and its treatment. The long-term impact of these Projects could lead to new directions in PTH treatment and a better understanding of why PTH occurs and why military Service Members and Veterans are at high risk for disability with PTH. Community-Based Participatory Research Approach and Implementation: All four projects of this focused program will rely on lived experience experts through two Community Advisory Boards (one emphasizing mTBI and the other psychological health). The boards and consultants will provide invaluable guidance on variables of significant interest for PTH and its treatment and will help the research team develop prediction models and assessment strategies that are relevant to Service Members and Veterans with PTH and not overly burdensome. Overview of the Effort: Project 1 will use patient and provider focus groups to identify headache symptoms that are the highest priority for treatment (which is vital because PTH symptoms are diverse) and outcomes of treatment that are most meaningful to patients. Project 2 will assess factors that predict response to nonpharmacological treatments for PTH (like relaxation/stress management, psychotherapy) and Project 3 will do the same for medications for PTH. Finally, Project 4 will develop an interactive diary that uses real-time input from patients about their headache and psychological health to predict when a heada
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252311046
Entities
People
- Donald D. McGeary
Organizations
- United States Army
- University of Texas Health Science Center at San Antonio