Feasibility Study of an Early, Interdisciplinary, Non-Pharmacological Intervention for Patients at Risk of Developing Persistent Post-Traumatic Headache: The PTHEENOT intervention.

PURPOSE: Persistent post-traumatic headache (PTH) is a disabling consequence of mild head injury, leading to functional impairment, reduced quality of life, and adverse vocational outcomes. Evidence-based treatments are limited, and early, interdisciplinary, non-pharmacological interventions have been proposed to prevent symptom persistence. This study assessed the feasibility and acceptability of PTHEENOT (Post-traumatic Headache - Early Engagement in Non-pharmacological Treatment), combining nurse-led Acceptance and Commitment Therapy-based psychoeducation with physiotherapy-guided activity and gradual return to daily life for patients at risk of persistent PTH.

PATIENTS AND METHODS: A convergent parallel mixed-methods design was used. Adults with acute PTH following mild head injury were recruited between June and October 2024. Quantitative feasibility outcomes included recruitment, retention, adherence, and questionnaire usability rather than intervention effectiveness. Six participants (mean age 40.8 years) completed a five-week intervention at a specialized headache clinic, and self-reported questionnaire data were analyzed descriptively. Qualitative data were obtained through a focus group interview, analyzed using a phenomenological-hermeneutic approach inspired by Ricoeur.

RESULTS: Recruitment was feasible following adjustments, though early symptom improvement and work commitments limited retention. Adherence among completers was high, and questionnaires were manageable. Participants reported perceived improvements in headache management, functional engagement, sleep quality, and self-efficacy. Four themes emerged: 1. Balancing meaningful engagement and program intensity, 2. Gradual improvement and mastery, 3. Peer support is of great value in the recovery process, and 4. Experiences a lack of support and guidance during illness. Peer interactions were important for validation, motivation, and coping, while participants suggested extended session time and follow-up.

CONCLUSION: The PTHEENOT intervention was acceptable, feasible, and perceived as meaningful by participants, supporting early, interdisciplinary approaches to PTH management. Findings provide guidance for refining intervention structure, delivery, and recruitment strategies prior to a randomized controlled trial aimed at preventing persistent PTH and improving quality of life.