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Pediatric Post-Traumatic Headache and Implications for Return to Sport: A Narrative Review
Samantha L Irwin1, Joanne Kacperski2,3, Reena G Rastogi4,5,6
1Department of Neurology, University of California San Francisco, San Francisco, CA, USA.
Insights
Post-Traumatic Headache (PTH) is common after head injuries in children. Current return-to-sport guidelines may be too strict; symptom stability is proposed as a better approach for pediatric athletes.
Area of Science:
- Neurology
- Sports Medicine
- Pediatrics
Background:
- Post-Traumatic Headache (PTH) is a frequent and disabling symptom following mild traumatic brain injury (mTBI) in children.
- PTH often presents with migraine-like features.
- Limited evidence and guidelines exist for managing pediatric PTH and return-to-sport decisions.
Purpose of the Study:
- To review the implications of returning pediatric athletes with persistent PTH (PPTH) to sport.
- To explore alternative criteria for return-to-sport decisions in pediatric mTBI.
Main Methods:
- A narrative review of literature up to October 2019.
- Focused on pediatric PTH, concussion, mTBI, and return-to-sport protocols.
- Recommendations based on author consensus.
Main Results:
- Existing return-to-sport guidelines, requiring complete symptom freedom and medication cessation, may be overly restrictive.
- Symptom stability, rather than complete resolution, is proposed as a more practical criterion.
Conclusions:
- Strict adherence to current return-to-sport guidelines may not be feasible for all pediatric athletes with PPTH.
- The concept of 'symptom stability' offers a potentially more reasonable approach for guiding return-to-sport decisions.
Background:
Headache attributed to mild traumatic injury of the head (aka: mild traumatic brain injury, mTBI), frequently abbreviated to Post-Traumatic Headache (PTH), is one of the most common and disabling symptoms after a head injury. PTH often phenotypes to migraine. Evidence for treating PTH in the pediatric population is limited. Widely accepted guidelines do not exist to aid the clinician and there are currently no placebo-controlled trials for the pharmacologic management of PTH in this age group. Recommendations for when to return a child or adolescent to sport if they develop and/or are being treated for persistent PTH (PPTH) are lacking. The objective of this narrative review is to review the implications of returning an adolescent with PPTH to sport.
Methods:
Pediatric neurologists with special qualification in headache collaborated on this narrative review. Literature was searched up until Oct 2019 for articles pertaining to PTH, concussion, mTBI, and the return of a pediatric athlete to sport after mTBI. Article inclusion was at the discretion of the authors. There was author consensus regarding all recommendations made.
Conclusion:
The authors recommend that strict adherence to the guidelines that return to sport cannot occur until a child is symptom free at rest, off any medication, may be unreasonable in certain situations. Symptom stability is the proposed new concept for return to sport.
