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Volume 46 Number 9, 2009
   Pages 1071 — 1084

Abstract — Improving sleep: Initial headache treatment in OIF/OEF veterans with blast-induced mild traumatic brain injury

Robert L. Ruff, MD, PhD;1-2* Suzanne S. Ruff, PhD;3 Xiao-Feng Wang, PhD4

1Neurology Service and Polytrauma System of Care, Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCVAMC), Cleveland, OH; 2Department of Neurology, Case Western Reserve University, Cleveland, OH; 3Psychology Service and Polytrauma System of Care, LSCVAMC, Cleveland, OH; 4Department of Quantitative Health Sciences, The Cleveland Clinic, Cleveland, OH

Abstract — This was an observational study of a cohort of 126 veterans with mild traumatic brain injury caused by an explosion during deployment in Operation Iraqi Freedom or Operation Enduring Freedom (OIF/OEF); 74 of the 126 veterans had comorbidities including frequent, severe headaches and residual deficits on neurological examination, neuropsychological testing, or both. Of these veterans, 71 had posttraumatic stress disorder and only 5 had restful sleep. We examined whether treatment with sleep hygiene counseling and oral prazosin would improve sleep, headaches, and cognitive performance. Nine weeks after providing sleep counseling and initiating an increasing dosage schedule of prazosin at bedtime, 65 veterans reported restful sleep. Peak headache pain (0-10 scale) decreased from 7.28 +/- 0.27 to 4.08 +/- 0.19 (values presented as mean +/- standard deviation). The number of headaches per month decreased from 12.40 +/- 0.94 to 4.77 +/- 0.34. Montreal Cognitive Assessment scores improved from 24.50 +/- 0.49 to 28.60 +/- 0.59. We found these gains maintained 6 months later. This pilot study suggests that addressing sleep is a good first step in treating posttraumatic headaches in OIF/OEF veterans.

Key words: combat, concussion, explosion, headache, mild traumatic brain injury, OIF/OEF, pain, prazosin, PTSD, sleep.

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