Characteristics of post-traumatic headaches in children following mild traumatic brain injury and their response to treatment: a prospective cohort

被引:129
作者
Kuczynski, Andrea [1 ]
Crawford, Susan [2 ]
Bodell, Lisa [2 ]
Dewey, Deborah [1 ,2 ]
Barlow, Karen M. [1 ,2 ]
机构
[1] Univ Calgary, Calgary, AB, Canada
[2] Alberta Childrens Prov Gen Hosp, Res Inst, Calgary, AB T3B 6A8, Canada
关键词
POSTCONCUSSION SYNDROME; CHILDHOOD HEADACHES; ICHD-II; CLASSIFICATION; ADOLESCENTS; CONCUSSION; EDITION;
D O I
10.1111/dmcn.12152
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Aim Post-traumatic headaches (PTHs) following mild traumatic brain injury (mTBI) are common; however, few studies have examined the characteristics of PTHs or their response to treatment. The aims of this study were (1) to describe the clinical characteristics of PTH in a prospective cohort of children presenting to a paediatric emergency department with mTBI, and (2) to evaluate the response of PTH to treatment. Method The emergency department cohort was obtained from a prospective longitudinal cohort study of symptoms following mTBI (n=670; 385 males, 285 females) and a comparison group of children with extracranial injury (n=120; 61 males, 59 females). A retrospective chart review of a separate cohort of children from a brain injury clinic (the treatment cohort) treated for PTH was performed (n=44; 29 females, 15 males; mean age 14y 1mo, SD 3y 1mo). The median time since injury was 6.9months (range 1-29mo). The mean follow-up interval after treatment started was 5.5weeks (SD 4.3wks). Results Among the emergency department cohort (n=39; 20 males, 19 females; mean age 11y 1mo, SD 4y 3mo) 11% of children were symptomatic with PTHs at a mean of 15.8days (SD 11.6d) post injury. Three months post injury, 7.8% of children complained of headaches; of those, 56% had pre-existing headaches and 18% had experienced migraine before the injury. Although headache type varied, 55% met the criteria for migraine. A family or past medical history of migraine was present in 82% of cases. Among the treatment cohort, medications included amitriptyline, flunarizine, topiramate, and melatonin, with an overall response rate of 64%. Conclusion This is the first prospective cohort study to describe the clinical characteristics of PTHs following mTBI in children. Migraine was the most common headache type seen; other headaches included tension-type, cervicogenic, and occipital neuralgias, and 64% responded to treatment. Referral to a headache specialist should be considered, especially when the features are not typical of one of the primary headache disorders.
引用
收藏
页码:636 / 641
页数:6
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