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Headache in traumatic brain injuries from blunt head trauma
Peter S Dayan1, James F Holmes2, John Hoyle3
1Division of Pediatric Emergency Medicine, Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, New York, New York; psd6@columbia.edu.
Pediatrics
|February 4, 2015
Summary
Children with isolated headaches after minor head trauma rarely have traumatic brain injuries (TBIs). This study found clinically important TBIs in 0% and CT-visible TBIs in less than 1% of these cases.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma Research
- Clinical Pediatrics
Background:
- Headaches are common in children after minor blunt head trauma.
- Distinguishing between isolated headaches and those associated with traumatic brain injury (TBI) is crucial for appropriate clinical management.
- Previous studies have not fully elucidated the risk of TBI in children presenting solely with headaches.
Purpose of the Study:
- To assess the risk of clinically important traumatic brain injuries (ciTBIs) and computed tomography (CT) visible TBIs in children experiencing isolated headaches following minor blunt head trauma.
- To evaluate the association between headache characteristics (severity, location) and TBI risk in this pediatric population.
Main Methods:
- Secondary analysis of a prospective observational study involving children aged 2-18 years with minor blunt head trauma (Glasgow Coma Scale scores 14-15).
- Clinicians documented headache history and characteristics at initial evaluation.
- Outcomes included clinically important TBI (ciTBI) and TBI identified on CT scan.
Main Results:
- Of 27,495 eligible patients, 12,675 (46.1%) reported headaches. Among those with complete data, 2,462 (19.6%) had isolated headaches.
- No clinically important TBIs (ciTBIs) were observed in the isolated headache group (0%; 95% CI: 0%-0.1%), compared to 1.6% in the non-isolated headache group.
- TBIs visible on CT were rare in the isolated headache group (0.7%; 95% CI: 0.1%-1.9%) versus 4.5% in the non-isolated headache group.
- Headache severity or location did not show significant independent associations with the risk of ciTBI or TBI on CT.
Conclusions:
- Clinically important traumatic brain injuries (ciTBIs) are rare in children with minor blunt head trauma when headaches are the sole presenting symptom.
- Computed tomography (CT) visible traumatic brain injuries (TBIs) are also uncommon in this specific pediatric subgroup.
- The findings suggest a low risk of significant head injury in children with isolated headaches after minor head trauma, supporting conservative management strategies.
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