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Popovich MJ, Wright BS, Bretzin AC, Roberts MT, Alsalaheen B, Almeida AA, Lorincz MT, Eckner JT. Headache Characteristics of Pediatric Sport-Related Concussion. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:813. [PMID: 39063391 PMCID: PMC11276358 DOI: 10.3390/ijerph21070813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/12/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Headache is among the most common symptoms following concussion, yet headache after concussion (HAC) remains poorly characterized. This study describes headache characteristics over the first four weeks following pediatric sport-related concussion. METHODS This is a retrospective case series of 87 athletes (mean: 14.9 years; range: 8.4-18.8 years; 38% female) treated in a specialty sports concussion clinic within 28 days of injury. Primary outcomes of headache consistency, frequency, duration, and associated migrainous symptoms were assessed at immediate (0 to 48 h) and weekly time points over the first 28 days post-injury. Generalized mixed linear models compared headache characteristics across time points. Secondary analyses compared each outcome by as-needed analgesic use. RESULTS During the immediate post-injury period, headache was more often constant (p = 0.002) and associated with migrainous symptoms (p < 0.001). By the third week post-injury, episodic headache was more prevalent (p < 0.001). Most patients (54%) transitioned from constant, migrainous headache to episodic, non-migrainous headache. This finding was uninfluenced by as-needed analgesic medication use. CONCLUSIONS These findings document the trajectory of HAC. Future studies should assess relationships between initial headache characteristics and recovery.
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Affiliation(s)
- Michael J. Popovich
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA; (M.T.R.); (A.A.A.); (M.T.L.)
| | - Brandon S. Wright
- Department of Kinesiology, University of Michigan, Ann Abror, MI 48109, USA;
| | - Abigail C. Bretzin
- Injury Prevention Center, Department of Emergency Medicine, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Mark T. Roberts
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA; (M.T.R.); (A.A.A.); (M.T.L.)
| | - Bara Alsalaheen
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA; (M.T.R.); (A.A.A.); (M.T.L.)
| | - Andrea A. Almeida
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA; (M.T.R.); (A.A.A.); (M.T.L.)
| | - Matthew T. Lorincz
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA; (M.T.R.); (A.A.A.); (M.T.L.)
| | - James T. Eckner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48109, USA;
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Eggertsen PP, Palmfeldt J, Schytz HW, Hay D, Olsen RKJ, Nielsen JF. Serum calcitonin gene-related peptide in patients with persistent post-concussion symptoms, including headache: a cohort study. J Neurol 2024; 271:2458-2472. [PMID: 38231270 PMCID: PMC11055722 DOI: 10.1007/s00415-024-12181-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Calcitonin gene-related peptide (CGRP) plays an important role in migraine pathophysiology, and post-traumatic headache (PTH) frequently presents with migraine-like features. Despite several clinical similarities, few studies have explored CGRP in PTH and concussion. This study investigates serum CGRP levels in patients with persistent post-concussion symptoms (PPCS), including PTH. METHODS This cohort study was based on serum samples from individuals aged 18-30 years with PPCS who participated in a previously published randomized controlled trial of a non-pharmacological intervention. The primary outcome was serum CGRP concentrations, determined at baseline before randomization and at follow-up 7 months later, using an enzyme-linked immunosorbent assay (ELISA). CGRP levels at baseline were compared with healthy anonymous blood donors in the same age group. RESULTS Baseline serum samples were collected from 86 participants with PPCS. The participants were most often female (78%) and migraine-like headache was the most frequent headache phenotype (74%). Serum CGRP levels were higher in participants with PPCS than in 120 healthy individuals (median: 158.5 pg/mL vs. 76.3 pg/mL, p = 0.050). A stratified analysis revealed that females with PPCS had a fivefold higher median than healthy females (166.3 pg/mL vs. 32.1 pg/mL, p = 0.0006), while no differences were observed in males (p = 0.83). At follow-up, CGRP levels decreased with a median change of - 1.3 pg/mL (95% confidence interval: - 17.6-0, p = 0.024). DISCUSSION Elevated serum levels of CGRP in patients with PPCS and a decrease over time suggest an involvement of CGRP in PTH/PPCS. If confirmed in other studies, it could pave the way for CGRP-targeted therapies, which could have clinical significance.
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Affiliation(s)
- Peter Preben Eggertsen
- Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Voldbyvej 15A, 8450, Hammel, Denmark.
- Department of Clinical Medicine, Research Unit for Molecular Medicine, Aarhus University Hospital and Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Johan Palmfeldt
- Department of Clinical Medicine, Research Unit for Molecular Medicine, Aarhus University Hospital and Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Henrik Winther Schytz
- Faculty of Health and Medical Sciences, Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, University of Copenhagen, Valdemar Hansens Vej 5, 2600, Glostrup, Denmark
| | - Debbie Hay
- Department of Pharmacology and Toxicology, University of Otago, 362 Leith Street, Dunedin North, Dunedin, 9016, New Zealand
| | - Rikke Katrine Jentoft Olsen
- Department of Clinical Medicine, Research Unit for Molecular Medicine, Aarhus University Hospital and Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Jørgen Feldbæk Nielsen
- Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Voldbyvej 15A, 8450, Hammel, Denmark
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da Silva Fiorin F, do Espírito Santo CC, Da Silva JT, Chung MK. Inflammation, brain connectivity, and neuromodulation in post-traumatic headache. Brain Behav Immun Health 2024; 35:100723. [PMID: 38292321 PMCID: PMC10827408 DOI: 10.1016/j.bbih.2024.100723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 02/01/2024] Open
Abstract
Post-traumatic headache (PTH) is a debilitating condition that affects individuals with different levels of traumatic brain injury (TBI) severity. The difficulties in developing an effective treatment are related to a lack of understanding the complicated mechanisms and neurobiological changes in brain function after a brain injury. Preclinical studies have indicated that peripheral and central sensitization of the trigeminal nociceptive pathways contributes to PTH. While recent brain imaging studies have uncovered widespread changes in brain functional connectivity following trauma, understanding exactly how these networks contribute to PTH after injury remains unknown. Stimulation of peripheral (trigeminal or vagus) nerves show promising efficacies in PTH experimental animals, likely mediated by influencing TBI-induced pathological plasticity by decreasing neuroinflammation and neuronal apoptosis. Non-invasive brain stimulations, such as transcranial magnetic or direct current stimulations, show analgesia for multiple chronic pain conditions, including PTH. Better mechanistic understanding of analgesia achieved by neuromodulations can define peripheral and central mechanisms involved in the development, the resolution, and the management of PTH.
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Affiliation(s)
- Fernando da Silva Fiorin
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Program in Neuroscience, Center to Advance Chronic Pain Research, Baltimore, MD, USA
| | - Caroline Cunha do Espírito Santo
- Graduate Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Brazil
| | - Joyce T. Da Silva
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Program in Neuroscience, Center to Advance Chronic Pain Research, Baltimore, MD, USA
| | - Man-Kyo Chung
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Program in Neuroscience, Center to Advance Chronic Pain Research, Baltimore, MD, USA
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4
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Fan F, Anderson V, Morawakage T, Khan N, Shapiro JS, Ignjatovic V, Takagi M. Post-traumatic headache pathophysiology in paediatric concussion: A systematic review. Neurosci Biobehav Rev 2024; 156:105498. [PMID: 38043751 DOI: 10.1016/j.neubiorev.2023.105498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/05/2023]
Abstract
Post-traumatic headache (PTH) represents the most common acute and persistent symptom following concussion in children, yet the underlying pathophysiology remains unclear. This systematic review sought to: (i) rigorously examine the current evidence of PTH pathophysiology in paediatric concussion (0-18 years), (ii) assess the quality of evidence, and (iii) provide directions for future research in accordance with PRISMA guidelines. Eligible studies (n = 19) totalling 1214 concussion participants investigated cerebrovascular function (n = 6), white matter integrity (n = 3), functional connectivity (n = 3), electrophysiology (n = 1), neurometabolics (n = 2), biological fluid markers (n = 4), vestibular and oculomotor function (n = 4); two studies used a multi-modal approach. Majority of studies were rated as fair quality (90%) and Level 3 evidence (84%). The true underlying mechanisms of PTH following paediatric concussion remain unclear. Overall quality of the available evidence is generally weak with a fair risk of bias and characterised by relative scarcity and lack of specificity of PTH pathophysiology. Future research is required to rigorously isolate pathophysiology specific to PTH with strict adherence to clinical definitions and standardised measurement tools of PTH.
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Affiliation(s)
- Feiven Fan
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia.
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia; Psychology Service, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | | | - Noor Khan
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Jesse S Shapiro
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Vera Ignjatovic
- Department of Paediatrics, University of Melbourne, Victoria, Australia; Institute for Clinical & Translational Research, Johns Hopkins All Children's, St Petersburg, FL, USA; Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia; Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
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Herrero Babiloni A, Bouferguene Y, Exposto FG, Beauregard R, Lavigne GJ, Moana-Filho EJ, Arbour C. The prevalence of persistent post-traumatic headache in adult civilian traumatic brain injury: a systematic review and meta-analysis on the past 14 years. Pain 2023; 164:2627-2641. [PMID: 37390366 DOI: 10.1097/j.pain.0000000000002949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/23/2023] [Indexed: 07/02/2023]
Abstract
ABSTRACT The most recent prevalence estimate of post-traumatic headache (PTH) after traumatic brain injury (TBI) in veterans and civilians dates back to 2008. The prevalence was found to be 57.8%, with surprising higher rates (75.3%) in mild TBI when compared with those with moderate/severe TBI (32.1%). However, the revision of mild TBI diagnostic criteria and an historic peak of TBI in the elderly individuals attributed to the ageing population may lead to different results. Thus, we conducted a systematic review and meta-analysis to assess the updated prevalence of PTH during the past 14 years only in civilians. A literature search was conducted following PRISMA guidelines guided by a librarian. Screening, full-text assessment, data extraction, and risk of bias assessment were performed blindly by 2 raters. Meta-analysis of proportions using the Freeman and Tukey double arcsine method of transformation was conducted. Heterogeneity, sensitivity analysis, and meta-regressions were performed with the predictors: year of publication, mean age, sex, TBI severity, and study design. Sixteen studies were selected for the qualitative analysis and 10 for the meta-analysis. The overall prevalence estimate of PTH was 47.1%, (confidence interval = 34.6, 59.8, prediction intervals = 10.8, 85.4), being similar at different time points (3, 6, 12, and 36+ months). Heterogeneity was high, and none of the meta-regressions were significant. The overall prevalence of PTH after TBI over the past 14 years remains high even if assessed only in civilians. However, the prevalence rates attributed to mild and moderate/severe TBI were similar, differing significantly from previous reports. Efforts are needed to improve TBI outcomes.
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Affiliation(s)
- Alberto Herrero Babiloni
- Division of Experimental Medicine, McGill University, Montréal, QC, Canada
- Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, QC, Canada
| | - Yasmine Bouferguene
- Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, QC, Canada
| | - Fernando G Exposto
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
- Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - Roxanne Beauregard
- Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, QC, Canada
| | - Gilles J Lavigne
- Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, QC, Canada
- Faculty of Dental Medicine, Université de Montréal, QC, Canada
| | - Estephan J Moana-Filho
- Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, MN, United States
| | - Caroline Arbour
- Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, QC, Canada
- Faculty of Nursing, Université de Montréal, QC, Canada
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McPherson JI, Nazir MSZ, Willer BS, Leddy JJ, Haider MN. Does Physiologic Post-Concussion Disorder Cause Persistent Post-Traumatic Headache? Curr Pain Headache Rep 2023; 27:793-799. [PMID: 37831366 DOI: 10.1007/s11916-023-01176-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE OF REVIEW One system classifies patients with symptoms after concussion into physiologic, vestibulo-ocular, cervicogenic, and mood/cognition post-concussion disorders (PCD) based upon the preponderance of specific symptoms and physical impairments. This review discusses physiologic PCD and its potential relationship to the development of persistent post-traumatic headaches (PPTH). RECENT FINDINGS Headache is the most reported symptom after a concussion. Headaches in physiologic PCD are suspected to be due to abnormal cellular metabolism, subclinical neuroinflammation, and dysfunction of the autonomic nervous system (ANS). These abnormalities have been linked to the development of migraine-like and neuralgia-related PPTH. Physiologic PCD is a potential cause of PPTH after a concussion. Future research should focus on how to prevent PPTH in patients with physiologic PCD.
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Affiliation(s)
- Jacob I McPherson
- Department of Rehabilitation Science, School of Public Health and Health Professions, State University of New York at Buffalo, 534 Kimball Tower, Buffalo, NY, 14214, USA.
| | - Muhammad S Z Nazir
- Concussion Management Clinic and Research Center, UBMD Orthopedics and Sports Medicine, State University of New York at Buffalo, Buffalo, NY, 14214, USA
| | - Barry S Willer
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, 14215, USA
| | - John J Leddy
- Department of Orthopedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, 14215, USA
| | - Mohammad N Haider
- Department of Orthopedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, 14215, USA
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Wijeratne T, Wijeratne C, Korajkic N, Bird S, Sales C, Riederer F. Secondary headaches - red and green flags and their significance for diagnostics. eNeurologicalSci 2023; 32:100473. [PMID: 37456555 PMCID: PMC10339125 DOI: 10.1016/j.ensci.2023.100473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/22/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
A small percentage of patients suffer from a secondary headache syndrome. It is imperative that clinicians are able to differentiate primary headache syndromes from secondary headache syndromes, as failure to do so significantly worsens morbidity and mortality. Recent advances in our understanding of pathobiological mechanisms offer useful information on these enigmatic disorders. We now understand that the causes of secondary headache syndromes can vary significantly - these may be infectious, inflammatory, vascular, traumatic or structural in origin. A well-taken history and targeted physical examination coupled with appropriate investigations can enable these syndromes to be recognized consistently and thus allow their timely and appropriate treatment. Along with their epidemiology, some of their key characteristics shall thus be discussed in this review so as to aid the busy clinician at the bedside. Red flags including sudden onset, high pain intensity, pattern of change of a preexisting headache, focal neurological signs or seizure, systemic signs and precipitation by physical activity can guide the clinician to suspect a secondary headache. Importantly a preexisting headache is not an exclusion of a secondary headache - it might even be a predisposition in certain cases.
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Affiliation(s)
- Tissa Wijeratne
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Department of Neurology, Western Health & University Melbourne, AIMSS, Level Three, WHCRE, Sunshine Hospital, St Albans 3021, Australia
- Department of Medicine, Faculty of Medicine, University of Rajarata, Saliyapura, Anuradhapura, Sri Lanka
| | - Chanith Wijeratne
- Monash Medical School, Clayton, Victoria, Australia
- Migraine Foundation & Australian Institute of Migraine, 522, Bell Street, Pascoe Vale South, Victoria, Australia
| | - Nadja Korajkic
- Department of Neurology, Western Health & University Melbourne, AIMSS, Level Three, WHCRE, Sunshine Hospital, St Albans 3021, Australia
| | - Stefanie Bird
- Department of Neurology, Western Health & University Melbourne, AIMSS, Level Three, WHCRE, Sunshine Hospital, St Albans 3021, Australia
- Migraine Foundation & Australian Institute of Migraine, 522, Bell Street, Pascoe Vale South, Victoria, Australia
| | - Carmela Sales
- Department of Neurology, Western Health & University Melbourne, AIMSS, Level Three, WHCRE, Sunshine Hospital, St Albans 3021, Australia
| | - Franz Riederer
- Department of Neurology, Clinic Hietzing and Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
- Faculty of Medicine, University of Zurich, Switzerland
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van Ierssel JJ, Tang K, Beauchamp M, Bresee N, Cortel-LeBlanc A, Craig W, Doan Q, Gravel J, Lyons T, Mannix R, Orr S, Zemek R, Yeates KO. Association of Posttraumatic Headache With Symptom Burden After Concussion in Children. JAMA Netw Open 2023; 6:e231993. [PMID: 36884251 PMCID: PMC9996395 DOI: 10.1001/jamanetworkopen.2023.1993] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/22/2023] [Indexed: 03/09/2023] Open
Abstract
Importance Headache is the most common symptom after pediatric concussion. Objectives To examine whether posttraumatic headache phenotype is associated with symptom burden and quality of life 3 months after concussion. Design, Setting, and Participants This was a secondary analysis of the Advancing Concussion Assessment in Pediatrics (A-CAP) prospective cohort study, conducted September 2016 to July 2019 at 5 Pediatric Emergency Research Canada (PERC) network emergency departments. Children aged 8.0-16.99 years presenting with acute (<48 hours) concussion or orthopedic injury (OI) were included. Data were analyzed from April to December 2022. Exposure Posttraumatic headache was classified as migraine or nonmigraine headache, or no headache, using modified International Classification of Headache Disorders, 3rd edition, diagnostic criteria based on self-reported symptoms collected within 10 days of injury. Main Outcomes and Measures Self-reported postconcussion symptoms and quality-of-life were measured at 3 months after concussion using the validated Health and Behavior Inventory (HBI) and Pediatric Quality of Life Inventory-Version 4.0 (PedsQL-4.0). An initial multiple imputation approach was used to minimize potential biases due to missing data. Multivariable linear regression evaluated the association between headache phenotype and outcomes compared with the Predicting and Preventing Postconcussive Problems in Pediatrics (5P) clinical risk score and other covariates and confounders. Reliable change analyses examined clinical significance of findings. Results Of 967 enrolled children, 928 (median [IQR] age, 12.2 [10.5 to 14.3] years; 383 [41.3%] female) were included in analyses. HBI total score (adjusted) was significantly higher for children with migraine than children without headache (estimated mean difference [EMD], 3.36; 95% CI, 1.13 to 5.60) and children with OI (EMD, 3.10; 95% CI, 0.75 to 6.62), but not children with nonmigraine headache (EMD, 1.93; 95% CI, -0.33 to 4.19). Children with migraine were more likely to report reliable increases in total symptoms (odds ratio [OR], 2.13; 95% CI, 1.02 to 4.45) and somatic symptoms (OR, 2.70; 95% CI, 1.29 to 5.68) than those without headache. PedsQL-4.0 subscale scores were significantly lower for children with migraine than those without headache only for physical functioning (EMD, -4.67; 95% CI, -7.86 to -1.48). Conclusions and Relevance In this cohort study of children with concussion or OI, those with posttraumatic migraine symptoms after concussion had higher symptom burden and lower quality of life 3 months after injury than those with nonmigraine headache. Children without posttraumatic headache reported the lowest symptom burden and highest quality of life, comparable with children with OI. Further research is warranted to determine effective treatment strategies that consider headache phenotype.
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Affiliation(s)
| | - Ken Tang
- Independent statistical consultant
| | - Miriam Beauchamp
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
- CHU Sainte-Justine Hospital Research Centre, Montreal, Québec, Canada
| | - Natalie Bresee
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Canada
- Department of Emergency Medicine, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - William Craig
- Department of Pediatrics, University of Alberta, Edmonton, Canada
- Stollery Children’s Hospital, Edmonton, Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
- BC Children’s Hospital Research Institute , Vancouver, Canada
| | - Jocelyn Gravel
- CHU Sainte-Justine Hospital Research Centre, Montreal, Québec, Canada
- Department of Pediatric Emergency Medicine, Université de Montréal, Montréal, Canada
| | - Todd Lyons
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Serena Orr
- Department of Pediatrics, University of Calgary, Calgary, Canada
- Alberta Children’s Hospital Research Institute, Calgary, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Roger Zemek
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Emergency Medicine, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Keith Owen Yeates
- Alberta Children’s Hospital Research Institute, Calgary, Canada
- Department of Psychology, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, Calgary, Canada
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Kasch H, Carstensen T, Ravn SL, Andersen TE, Frostholm L. Cervical Motor and Nociceptive Dysfunction After an Acute Whiplash Injury and the Association With Long-Term Non-Recovery: Revisiting a One-Year Prospective Cohort With Ankle Injured Controls. FRONTIERS IN PAIN RESEARCH 2022; 3:906638. [PMID: 35875480 PMCID: PMC9300940 DOI: 10.3389/fpain.2022.906638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Aims To explore the development of cervical motor and nociceptive dysfunction in patients with whiplash (WPs) and non-recovery based on injury-related work disability 1-year after injury when compared with ankle-injured controls (ACs). Methods A 1-year observational prospective study examining consecutive WPs and age- and sex-matched ACs at 1 week,3 months, 6 months, and 1 year post-injury using semi-structured interviews; global pain rating (VAS0-10) and the pain rating index (PRI-T) and number-of-words-chosen (NWC) from the McGill Pain Questionnaire; examining nociceptive functioning using the cold pressor test (CPT), pressure algometry, and methodic palpation, and central pain processing using counter-stimulation; and examining motor functioning by active cervical range-of-motion (CROM), and neck strength [maximal voluntary contraction flexion/extension (MVC)]. One-year work disability/non-recovery was determined using a semi-structured interview. Results A total of 141 WPs and 40 ACs were included. Total pain rating index (PRI-T) NWC were higher in ACs after 1 week but higher in WPs after 3 months, 6 months, and 1 year. Ongoing global pain was higher in WPs after 1 week and after 3 and 6 months but not after 1 year. Pressure pain thresholds were reduced, and palpation was higher in the neck and jaw in WPs after 1 week but was not consistently different afterward from ACs. Cervical mobility was reduced in WPs after 1 week, 3 months, and 6 months but not after 1 year, and MVC was significantly reduced in WPs when compared with ACs after 1 week and 1 year but not after 3 and 6 months. One-year non-recovery was only encountered in 11 WPs and not in the AC group. Non-recovered WPs (N-WPs) had consistently significantly higher VAS0−10, PRI-T, NWC, reduced pressure pain thresholds, raised muscle-tenderness, reduced active cervical range-of-motion, reduced active-neck-flexion/extension, and reported higher neck disability scores than recovered WPs. Of special interest, there was increasing tenderness in trigeminal-derived muscles based on palpation scores, and marked reduction of PPDT was most pronounced in N-WPs when compared with recovered WPs and ACs. Conclusion Cervical motor dysfunction and segmental nociceptive sensitization were present from early after injury in WPs and prolonged in N-WPs. Differences in trigeminal and cervical motor and sensory function in N-WPs could be of interest for future treatment studies.
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Affiliation(s)
- Helge Kasch
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- *Correspondence: Helge Kasch
| | - Tina Carstensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Sophie Lykkegaard Ravn
- Specialized Hospital for Polio and Accident Victims, Roedovre, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | | | - Lisbeth Frostholm
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
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