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Patterson Gentile C, Rosenthal S, Blume H, Rastogi RG, McVige J, Bicknese A, Ladak A, Zaveri H, Greene K, Barlow K. American Headache Society white paper on treatment of post-traumatic headache from concussion in youth. Headache 2024. [PMID: 39073141 DOI: 10.1111/head.14795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To provide healthcare professionals guidance on youth at risk for prolonged recovery and post-traumatic headache (PTH), and on pharmacologic and non-pharmacologic management of PTH due to concussion and mild traumatic brain injury. BACKGROUND Headache is the most common persistent post-concussive symptom affecting 8% of youth for >3 months after concussion. Over the past decade, many studies have explored the treatment of PTH in youth, but there are no established guidelines. METHODS This white paper is based on a synthesis of an updated systematic review of the literature on treatment of PTH and a narrative review of the literature on risk factors for prolonged recovery and health disparities. Results were interpreted by a group of expert providers in PTH in children and adolescents through collaboration of the PTH and pediatric special interest groups of the American Headache Society. RESULTS Factors that consistently were associated with prolonged recovery from concussion and persistent PTH included female sex, a high number of acute symptoms, and adolescent age. Social determinants of health also likely play an important role in PTH and deserve consideration in the clinical and research settings. A total of 33 studies met the criteria for inclusion in the systematic review of PTH treatment in youth, although most were retrospective and of fair-to-poor quality. Treatment strategies included acute and preventive pharmacologic management, procedures, neuro-modulatory devices, physical therapy, physical activity, and behavioral health support. A collaborative care approach that includes a thoughtful combination of these management strategies is likely most effective. CONCLUSIONS This white paper provides a roadmap for tailoring the treatment of PTH based on factors influencing prolonged headache, the timing of therapies, and therapies with the most evidence for treating PTH in youth. We also highlight research needed for developing more definitive guidelines on PTH management in youth.
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Affiliation(s)
- Carlyn Patterson Gentile
- Division of Pediatric Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Scott Rosenthal
- Department of Pediatrics - Neurology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Heidi Blume
- Division of Pediatric Neurology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Reena Gogia Rastogi
- Division of Pediatric Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Jennifer McVige
- Pediatric Neurology, Pediatric and Adult Headache, Dent Neurologic Institute, Amherst, New York, USA
| | - Alma Bicknese
- Division of Pediatric Neurology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ali Ladak
- Division of Pediatric Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Harshul Zaveri
- Division of Child Neurology, Children's Hospital of Orange County, UC Irvine School of Medicine, Orange, California, USA
| | - Kaitlin Greene
- Division of Pediatric Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Karen Barlow
- Children's Hospital and Health Services, University of Queensland, Brisbane, Queensland, Australia
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Marbil MG, Ware AL, Galarneau JM, Minich NM, Hershey AD, Orr SL, Defta DM, Taylor HG, Bigler ED, Cohen DM, Mihalov LK, Bacevice A, Bangert BA, Yeates KO. Longitudinal trajectories of posttraumatic headache after pediatric mild traumatic brain injury. Cephalalgia 2023; 43:3331024231161740. [PMID: 37177818 DOI: 10.1177/03331024231161740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE This prospective, longitudinal cohort study examined the trajectory, classification, and features of posttraumatic headache after pediatric mild traumatic brain injury. METHODS Children (N = 213; ages 8.00 to 16.99 years) were recruited from two pediatric emergency departments <24 hours of sustaining a mild traumatic brain injury or mild orthopedic injury. At 10 days, three months, and six months postinjury, parents completed a standardized questionnaire that was used to classify premorbid and posttraumatic headache as migraine, tension-type headache, or not otherwise classified. Multilevel mixed effects models were used to examine posttraumatic headache rate, severity, frequency, and duration in relation to group, time postinjury, and premorbid headache, controlling for age, sex, and site. RESULTS PTH risk was greater after mild traumatic brain injury than mild orthopedic injury at 10 days (odds ratio = 197.41, p < .001) and three months postinjury (odds ratio = 3.50, p = .030), especially in children without premorbid headache. Posttraumatic headache was more frequent after mild traumatic brain injury than mild orthopedic injury, β (95% confidence interval) = 0.80 (0.05, 1.55). Groups did not differ in other examined headache features and classification any time postinjury. CONCLUSIONS Posttraumatic headache risk increases after mild traumatic brain injury relative to mild orthopedic injury for approximately three months postinjury, but is not clearly associated with a distinct phenotype.
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Affiliation(s)
- Mica Gabrielle Marbil
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Ashley L Ware
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | | | - Nori Mercuri Minich
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
- Rainbow Babies & Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Andrew D Hershey
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Serena L Orr
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Dana M Defta
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - H Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Erin D Bigler
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Daniel M Cohen
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
- Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Leslie K Mihalov
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Ann Bacevice
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - Barbara A Bangert
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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Dondi A, Biserni GB, Scarpini S, Fetta A, Moscano F, Corsini I, Borelli G, Cordelli DM, Lanari M. Post-Traumatic Headache in Children after Minor Head Trauma: Incidence, Phenotypes, and Risk Factors. CHILDREN 2023; 10:children10030534. [PMID: 36980092 PMCID: PMC10047862 DOI: 10.3390/children10030534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023]
Abstract
Minor head trauma (MHT) is very frequent in children and post-traumatic headache (PTH) is one of its most common complications; however, its management is still a challenge. We aimed to assess the incidence and clinical characteristics of, and risk factors for, PTH among children referred to our pediatric emergency department (PED) for MHT. A total of 193 patients aged 3–14 years evaluated for MTH were enrolled and followed up for 6 months through phone calls and/or visits. PTH occurred in 25/193 patients (13%). PTH prevalence was significantly higher in school-aged (≥6 years) than in pre-school-aged children (21.6% vs. 4.9%, respectively, p < 0.009). Females were found to be more affected. The median time of onset was 4.6 days after MHT; resolution occurred in a median of 7 weeks. In 83.3% of patients, PTH subsided in <3 months, while in 16.7% it persisted longer. A total of 25% of children exhibited the migraine and 75% the tension-type variant. Our analysis indicates the presence of headache upon arrival in PED, isolated or associated with nausea and dizziness, as a factor predisposing the patient to the development of PTH. Our findings could be useful to identify children at risk for PTH for specific follow-up, family counseling, and treatment.
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Affiliation(s)
- Arianna Dondi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | - Sara Scarpini
- Specialty School of Pediatrics, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
- Correspondence:
| | - Anna Fetta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell’età Pediatrica, 40139 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), S. Orsola Hospital, University of Bologna, 40126 Bologna, Italy
| | - Filomena Moscano
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell’età Pediatrica, 40139 Bologna, Italy
| | - Ilaria Corsini
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Greta Borelli
- Department of Nephrology, Dialysis and Transplantation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum, University of Bolologna, 40126 Bologna, Italy
| | - Duccio Maria Cordelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell’età Pediatrica, 40139 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), S. Orsola Hospital, University of Bologna, 40126 Bologna, Italy
| | - Marcello Lanari
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Baiden P, Morgan MA, Logan MW. Sports- and Physical Activity-Related Concussions, Binge Drinking and Marijuana Use among Adolescents: The Mediating Role of Depression and Suicidal Ideation. Subst Use Misuse 2022; 57:504-515. [PMID: 34967277 DOI: 10.1080/10826084.2021.2019779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although past studies have examined the adverse impact of sports- and physical activity-related concussions (SPACs) on health and mental health outcomes, there is a dearth of research investigating the association between SPACs and binge drinking and marijuana use. OBJECTIVE The objective of this study is to examine the cross-sectional association between SPACs and binge drinking and marijuana use among adolescents and whether symptoms of depression and suicidal ideation mediate this association. METHODS Data for this study came from the 2017 and 2019 National Youth Risk Behavior Survey. An analytic sample of 17,175 adolescents aged 14-18 years (50.2% male) was analyzed using binary logistic regression. RESULTS Of the 17,175 adolescents, 13.7% engaged in binge drinking and 19.3% used marijuana 30 days preceding the survey date. Approximately one in seven (14.1%) adolescents had SPACs during the past year. Upon controlling for the effects of other factors, adolescents who had SPACs had 1.74 times higher odds of engaging in binge drinking (AOR = 1.74, p<.001, 95% CI = 1.47-2.06) and 1.42 times higher odds of using marijuana (AOR = 1.42, p<.001, 95% CI = 1.24-1.62) than those who did not have SPACs. Symptoms of depression and suicidal ideation explained 12% of the association between SPACs and binge drinking, and 19% of the association between SPACs and marijuana use. CONCLUSIONS Understanding the association between SPACs and substance use and mental health could contribute to early identification of adolescents who may engage in substance use.
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Affiliation(s)
- Philip Baiden
- School of Social Work, The University of Texas at Arlington, Arlington, Texas, USA
| | - Mark A Morgan
- Department of Criminal Justice & Security Studies, University of Dayton, Dayton, Ohio, USA
| | - Matthew W Logan
- School of Criminal Justice & Criminology, Texas State University, San Marcos, Texas, USA
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Doll E, Gong P, Sowell M, Evanczyk L. Post-traumatic Headache in Children and Adolescents. Curr Pain Headache Rep 2021; 25:51. [PMID: 34086145 DOI: 10.1007/s11916-021-00967-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Post-traumatic headache is a common disorder in the pediatric age group, seen both by child neurologists and by non-neurologists. The current review of post-traumatic headache in children and adolescents aims to review the pathophysiology, risk factors, clinical features, neuroimaging, and both acute and preventive treatment options. RECENT FINDINGS Recent literature provides insight into specific risk factors in the pediatric age group for developing post-traumatic headache as well as unique pathophysiologic changes seen in neuroimaging and neurometabolic pathways. It also elucidates common treatment options and novel treatments being currently explored, such as with monoclonal antibodies to CGRP. Finally, current evidence and guidelines recommend the benefit of a gradual return to normal activity based on symptom stability rather than a specific time period. Review of literature on pediatric post-traumatic headache reveals a growing understanding of the factors involved in developing headache after head trauma and the diagnosis/treatment of headache though future research will help further elucidate these areas.
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Affiliation(s)
- Elizabeth Doll
- Department of Neurology, University of Louisville School of Medicine, 500 S Preston St, 113-a HSC, Louisville, KY, 40202, USA
| | - Paul Gong
- Department of Neurology, University of Louisville School of Medicine, 500 S Preston St, 113-a HSC, Louisville, KY, 40202, USA.
| | - Michael Sowell
- Department of Neurology, University of Louisville School of Medicine, 500 S Preston St, 113-a HSC, Louisville, KY, 40202, USA
| | - Lauren Evanczyk
- Norton Children's Neuroscience Institute, Norton Healthcare, Louisville, KY, USA
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