Hundreds of thousands of U.S. veterans have reported at least one traumatic brain injury, which is often linked to chronic post-traumatic headaches and post-traumatic stress disorder. PTSD can make headache pain worse, according to Don McGeary, a professor and vice chair for research in the departments of psychiatry and behavioral sciences at UT Health San Antonio.
"It makes it more difficult for those individuals to respond well to treatments," McGeary said. "It increases the likelihood that they'll be emotionally compromised by their headache, and that includes suicide risk. And it decreases the likelihood that they'll respond to the usual frontline medications that are given to individuals who have headaches."
McGeary is also a senior research health scientist at the South Texas VA, and he's discovered that cognitive behavioral therapy (CBT) specifically designed for veterans with TBI who experience post-traumatic headaches significantly reduces headache disability and post-traumatic stress. "I think one of the reasons why we see that is because the CBT is not just addressing the headache," McGeary said. "It's addressing comorbid depression, it's addressing comorbid insomnia, and it's addressing comorbid PTSD."
McGeary suspects the benefits could be even greater with more personalized treatment, so he's training an artificial intelligence machine learning model. "These are models that create predictions and update themselves over time based on their interaction with the user," he explained.
How does it work? "We have people fill out pain diaries," McGeary said. "For my headache studies and my clinics, my patients will fill out their diaries twice a day, and they'll do it every day, and they'll do it for months. They're really good about it."
Patients begin with a comprehensive baseline evaluation, then they start filling out the diary, and soon, AI begins to recognize patterns and make predictions. If a patient has noted that they tend to have headaches when it's humid or rainy, the program will alert them when similar conditions are approaching. "It's like, 'Oh, hey, we're looking at the weather. It's more likely that you're going to have a headache tomorrow, so you might wanna do something about it,'" McGeary said.
Each person's triggers will be different, McGeary acknowledged, but the program asks a lot of questions, tracks patterns over time, and then creates a model specific to one individual that tries to predict their headaches. "And we've improved the predictive capacity of our models from 30% now to about 85%," he said.
The AI model uses the framework of CBT to build a patient's confidence that they can manage or even prevent their headaches. No longer at the mercy of pain that might seize them out of nowhere, they can begin to participate more fully in their own lives. Reducing the impact of headache pain on their well-being can also make the symptoms and challenges of their post-traumatic stress and TBI feel more manageable.
"In a way, cognitive and behavioral therapies are ideally suited to this kind of complex clinical picture because these treatments basically teach people how to cope with life in general," McGeary said.
As the AI model improves, McGeary hopes it will help researchers identify which behavioral treatments work better than others, improving treatment options for people experiencing chronic, post-traumatic headache. He also suspects it will help identify patients who might benefit from certain types of medications. "This will help us zero in on those folks so that physicians can match their treatments to specific patients who are most likely to benefit from them," he said.
Science & Medicine is a collaboration between TPR and The University of Texas Health Science Center at San Antonio, about how scientific discovery in San Antonio advances the way medicine is practiced everywhere.
