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Survey of Child Neurologists on Management of Pediatric Post-traumatic Headache
Rachel Pearson1, Desiree Levyim1, Meeryo Choe2
11 Children's Hospital Orange County, University of California-Irvine, Orange, CA, USA.
Insights
Pediatric post-traumatic headache management lacks guidelines, leading to varied clinical practices among child neurologists. Most use NSAIDs for acute treatment, but prophylaxis and return-to-activity protocols differ significantly.
Area of Science:
- Pediatric Neurology
- Neurotraumatology
- Headache Medicine
Background:
- Traumatic brain injury (TBI) is a significant cause of morbidity in children and adolescents.
- Headache is the most prevalent symptom following concussion in pediatric populations.
- Current management strategies for pediatric post-traumatic headache (PTH) lack established clinical guidelines.
Purpose of the Study:
- To investigate and characterize the current clinical practices of child neurologists in managing pediatric post-traumatic headache.
- To identify common diagnostic criteria, acute treatment modalities, and prophylactic approaches used for pediatric PTH.
- To understand the variability in recommendations regarding rest and return to activities after pediatric concussion.
Main Methods:
- A survey was distributed to 95 child neurologists to gather data on their practices.
- The survey assessed patient volume, diagnostic criteria adherence (e.g., International Classification of Headache Disorders), and treatment strategies.
- Data on the use of abortive and prophylactic medications, as well as recommendations for rest and activity, were collected.
Main Results:
- Most surveyed neurologists evaluate fewer than 50 pediatric concussion patients annually.
- Only 38.9% of practitioners consistently utilize International Classification of Headache Disorders criteria for PTH diagnosis.
- Nonsteroidal anti-inflammatory drugs are commonly recommended for abortive therapy, with varied timing and frequency; prophylactic treatments include amitriptyline, topiramate, and supplements, with inconsistent initiation timing.
Conclusions:
- Considerable variation exists in the clinical management of pediatric post-traumatic headache due to the absence of established guidelines.
- Practices regarding diagnosis, acute and prophylactic treatment, and return-to-activity protocols are inconsistent among child neurologists.
- Further research is essential to develop evidence-based guidelines for optimal pediatric PTH management.
Abstract:
Traumatic brain injury causes significant morbidity in youth, and headache is the most common postconcussive symptom. No established guidelines exist for pediatric post-traumatic headache management. We aimed to characterize common clinical practices of child neurologists. Of 95 practitioners who completed our survey, most evaluate <50 pediatric concussion patients per year, and 38.9% of practitioners consistently use International Classification of Headache Disorders criteria to diagnose post-traumatic headache. Most recommend nonsteroidal anti-inflammatory drugs as abortive therapy, though timing after injury and frequency of use varies, as does the time when providers begin prophylactic medications. Amitriptyline, topiramate, and vitamins/supplements are most commonly used for prophylaxis. Approach to rest and return to activities varies; one-third recommend rest for 1 to 3 days and then progressive return, consistent with current best practice. With no established guidelines for pediatric post-traumatic headache management, it is not surprising that practices vary considerably. Further studies are needed to define the best, evidence-based management for pediatric post-traumatic headache.
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