New treatment for Veterans’ old headaches

Following a concussion, some Veterans experience chronic, severe headaches that are difficult to treat. But thanks to VA’s new application of a versatile drug called prazosin, relief may be in sight.

Every year in the United States, an estimated 1.7 million people sustain a traumatic brain injury (TBI). Most TBIs are classified as mild TBIs, also known as concussions. For most people, concussions resolve quickly on their own, without treatment or any lasting effect. Even headaches, the most common problem following a concussion, usually occur for only a few months before tapering off.

But some people who have had a concussion experience severe headaches that can worsen over time. For some Veterans, these post-concussion headaches can be disabling and difficult to treat. Headaches related to blast-wave concussions from roadside bombs (like IEDs, or improvised explosive devices) seem to be particularly resistant to treatment.

Over the past decade, increasing evidence suggests that prazosin (sold under the brands Minipress, Vasoflex and Lentopres) may lessen the severity and frequency of post-concussion headaches when taken regularly. Originally approved in 1974 as a treatment for high blood pressure, prazosin has since been used to treat symptoms of enlarged prostate, a rare circulatory disorder called Raynaud’s disease, and trauma nightmares and sleep disruption related to posttraumatic stress disorder (PTSD).

Prazosin exploratory findings

After hearing a lecture by Dr. Murray Raskind on prazosin’s beneficial effects in treating combat-related PTSD symptoms, Dr. Robert Ruff–then VA’s national director for neurology–explored using prazosin to treat PTSD-related nightmares and sleep disturbances among Iraq and Afghanistan Veterans who had experienced post-concussion headaches. Dr. Ruff observed that, in addition to experiencing substantially improved restorative sleep and reduced daytime sleepiness, participants in his study had significant reductions in both frequency and intensity of post-concussion headaches

After nine weeks of daily treatment with prazosin, the Veterans in Dr. Ruff’s study reported an average reduction from 12 headaches a month down to five, and an average decrease in pain intensity from a nine on the 10-point scale to a four. While it’s not clear how prazosin works on headaches, one theory is that it improves sleep and may help clear inflammatory agents from the brain.

Although Dr. Ruff’s observations were very encouraging, they needed to be validated by a study comparing the use of prazosin to a placebo in treating people with chronic post-concussion headaches. Researchers at the VA Puget Sound Health Care System (VISN 20) are now conducting that study, and their preliminary results are promising. Among study participants who have completed the six-month clinical trial, prazosin appears to work significantly better than a placebo in reducing the frequency and severity of headaches.

Versus other treatments

Prazosin seems to have about the same success rate as other preventive headache therapies and may provide an effective option for Veterans whose headaches have been resistant to other treatments. Additionally, prazosin is widely available, including as an inexpensive generic, and it’s not habit-forming. It has few side effects and can be used to simultaneously treat different symptoms, such as post-concussion headaches and PTSD.

As researchers in VISN 20 continue to explore prazosin, they remain committed to ensuring that it is both safe and effective.

For the time being, all meetings typically held in person at the VA Puget Sound and Madigan Army Medical Center have been suspended. The team is working with currently enrolled participants remotely via telehealth. Currently, the team has continued prescreening Veterans and service members interested in study participation by phone, but no additional members will be enrolled until further notice.

Those interested in learning more about the ongoing study of prazosin’s effect on headaches related to a concussion can find out more by reading the study fact sheet at www.mirecc.va.gov/visn20/docs/PTH.pdf

VISN 20 Northwest MIRECC

For more information on the VISN 20 MIRECC, visit https://www.mirecc.va.gov/visn20.

Cindy Mayer, D.O., is a research neurologist and clinical nuclear medicine physician at the VA Puget Sound Health Care System in Seattle. Dr. Mayer is the VA Principal Investigator for the Chronic Postconcussive Headache: A Placebo-Controlled Treatment Trial of Prazosin Study. 

Murray A. Raskind, M.D., is a professor of psychiatry and behavioral sciences at the University of Washington and directs the VISN 20 Northwest MIRECC. Dr. Raskind discovered that prazosin is effective in treating PTSD-related trauma nightmares, sleep disruption and daytime hyperarousal symptoms.