Beyond its primary use, a hypertension drug reveals its extraordinary potential in relieving headaches.

Persistent posttraumatic headaches are the primary long-term consequence of mild traumatic brain injuries (concussions) in Veterans and active-duty service members. These headaches resemble migraines but do not respond well to standard prevention treatments for migraines, leading to significant distress and disability in both home and work environments.

In a recent study conducted by researchers at the VA Puget Sound Health Care System, it was discovered that prazosin, a medication commonly used to treat high blood pressure, can effectively prevent posttraumatic headaches. Prazosin, classified as an alpha-blocker, works by relaxing blood vessels, thereby facilitating smoother blood flow throughout the body.

Its common side effects include weakness, tiredness, headache, and nausea.

While prazosin was originally approved by the FDA in 1976 for hypertension, it has been utilized “off-label” to address conditions such as PTSD-associated nightmares and enlarged prostate. Previous research conducted by the same group of researchers had suggested that prazosin might also alleviate the frequency and severity of headaches resulting from traumatic brain injuries.

To investigate this potential effect, the researchers conducted a pilot study involving 48 Veterans and service members experiencing headaches caused by mild traumatic brain injuries, commonly known as concussions. Over the course of five weeks, participants were administered gradually increasing doses of prazosin until they reached the maximum dose, which they continued taking for 12 weeks. The study demonstrated that prazosin was well-tolerated, with morning drowsiness being the sole reported adverse effect.

Prior to the trial, participants experienced an average of 18 headache days per month. By the conclusion of the 12-week period, those taking prazosin reported an average of only six headache days per month. Participants who received a placebo experienced some reduction in headaches but still endured approximately 12 headache days per month. Importantly, a significantly greater number of participants in the prazosin group reported experiencing at least a 50% reduction in headaches during the 12-week treatment period.

Moreover, participants taking prazosin noted a substantial improvement in the impact of headaches on their quality of life. By the end of the trial, they reported that headaches had only a mild effect on their daily functioning, while those who received a placebo continued to experience severe impairment due to headaches.

While larger clinical trials are required to validate these promising findings, the initial results offer potential relief for a widespread ailment among Veterans. The researchers emphasize the significance of this study as the only clinical trial thus far to demonstrate the efficacy of oral medication in treating posttraumatic headaches. Given that prazosin is already widely prescribed within the VA and the Department of Defense to address PTSD-related nightmares and sleep disturbances, healthcare providers in these institutions are already familiar with the prescription of this cost-effective, readily available medication. As a result, prazosin now presents an evidence-based approach to alleviating the suffering experienced by Veterans and service members who have long struggled with frequent posttraumatic headaches.

Traumatic brain injury (TBI) has been identified as the “signature injury” of recent conflicts in Iraq and Afghanistan, affecting over 460,000 service members since 2000, with the majority being mild TBIs. Headaches frequently accompany mild TBIs and often persist chronically, causing significant disability and distress.

The findings of this study were published in the journal Headache, the Journal of Head and Face Pain.

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