Ruff Robert L, Ruff Suzanne S, Wang Xiao-Feng
Neurology Service, 127(W), Louis Stokes Cleveland VA Medical Center, 10701 East Blvd, Cleveland, OH 44106, USA.
J Rehabil Res Dev. 2009;46(9):1071-84. doi: 10.1682/jrrd.2009.05.0062.
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.
这是一项针对126名退伍军人的观察性研究，这些退伍军人在伊拉克自由行动或持久自由行动（OIF/OEF）部署期间因爆炸导致轻度创伤性脑损伤；126名退伍军人中有74人患有合并症，包括频繁、严重的头痛以及神经检查、神经心理学测试或两者均有残留缺陷。在这些退伍军人中，71人患有创伤后应激障碍，只有5人睡眠良好。我们研究了睡眠卫生咨询和口服哌唑嗪治疗是否能改善睡眠、头痛和认知表现。在提供睡眠咨询并在睡前开始增加哌唑嗪剂量方案九周后，65名退伍军人报告睡眠良好。头痛峰值疼痛（0至10分制）从7.28±0.27降至4.08±0.19（数值以平均值±标准差表示）。每月头痛次数从12.40±0.94降至4.77±0.34。蒙特利尔认知评估得分从24.50±0.49提高到28.60±0.59。我们发现这些改善在6个月后仍保持。这项初步研究表明，解决睡眠问题是治疗OIF/OEF退伍军人创伤后头痛的良好第一步。
