US researchers seek best way to tackle post-concussion headaches

Frank Porreca, is a professor of pharmacology at the University of Arizona's College of Medicine in Tucson.
Frank Porreca is a professor of pharmacology at the University of Arizona’s College of Medicine in Tucson.

Researchers in the United States hope to find the most effective ways to provide relief from post-traumatic headaches arising from concussions.

Headaches arising from mild traumatic brain injuries, commonly known as concussions, can be debilitating. Researchers with the University of Arizona Health Sciences, using a $US1.84 million Department of Defense grant, hope they can ease the burden.

“Headaches are the most common symptom associated with concussion,” says Frank Porreca,  a professor of pharmacology at the university’s College of Medicine in Tucson, who leads the study.

“They can be temporary and persist from a few days to a few months, they can go away, or they can never go away. If the headache persists for longer than three months after the concussion, then you have persistent post-traumatic headache, a debilitating condition that could end up ruining your life.”

More than 2.8 million Americans sustain mild traumatic brain injuries every year, according to the US Centers for Disease Control and Prevention. About 360,000 service members sustained traumatic brain injuries from 2000 to 2016 with more than 80% classified as mild, according to Department of Defense estimates.

Many people with post-traumatic headache report symptoms similar to migraine including headache, fatigue, loss of concentration, loss of executive function, lack of sleep, too much sleep, and hypersensitivity to light or sound, Dr Porreca says.

While there are US Food and Drug Association-approved medications that work for migraines in some people, there are no approved medications for post-traumatic headache.

In the new study, Dr Porreca, along with Edita Navratilova, assistant professor of pharmacology at the College of Medicine in Tucson, and Trent Anderson, associate professor of basic medical sciences at the university’s medical college in Phoenix, will work to identify the mechanisms behind these headaches to better understand how existing medications can be used to alleviate symptoms.

“We are not inventing therapies,” Dr Porreca explains. “We are looking at existing therapies, or those currently in clinical development, to see if these are effective.”

The study will investigate mechanisms associated with two potential therapies: Onabotulinum toxin A, marketed under the brand name Botox, which is currently used for migraine treatment; and a kappa-opioid receptor antagonist currently in Phase 2 clinical trials for anxiety disorders. Opioid receptors regulate motivational processes and are important players in brain regions that govern anxiety, reward processing, mood and cognition.

Researchers believe kappa-opioid receptor antagonists may prove to be safe, effective and non-addictive therapies for post-traumatic headache pain, which is often triggered by stress and by sleep-wake disturbances. They may also offer additional benefits important to the military population, such as anxiety reduction, anti-depressive effects and reduced addiction liability and relapse.

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