Clinical profile and short-term course of post-traumatic headache in children with mild traumatic brain injury: a
Purushottam Singh1,2, Devendra Mishra3,4, P N Pandey2
1Department of Pediatrics, Maulana Azad Medical College (University of Delhi) and associated Lok Nayak Hospital, Delhi 110002, India.
Insights
Post-traumatic headache (PTH) is common in children after mild traumatic brain injury (mTBI). Early diagnosis and management are crucial for children experiencing mTBI and subsequent headaches.
Area of Science:
- Pediatric Neurology
- Traumatology
- Headache Medicine
Background:
- Mild traumatic brain injury (mTBI) is a common pediatric injury.
- Post-traumatic headache (PTH) is a frequent complication following mTBI in children.
- Understanding the clinical profile and risk factors for PTH is essential for effective management.
Purpose of the Study:
- To investigate the clinical characteristics of children with mTBI.
- To identify factors associated with the development of post-traumatic headache (PTH) in pediatric mTBI patients.
- To inform clinical practice for diagnosing and managing PTH in children.
Main Methods:
- A cohort of 130 children aged 6-12 years with mTBI was enrolled.
- Participants were followed for 7 days to identify acute PTH.
- Children with PTH received monthly follow-up for 3 months to assess persistent PTH.
Main Results:
- 23.1% of children developed PTH, with 19.2% experiencing acute PTH and 3.8% developing persistent PTH.
- Bilateral headache and squeezing quality were common features.
- Nausea and vomiting were significantly associated with PTH development after mTBI.
- Obesity, female gender, family history of headache, and prior concussion were not associated with increased PTH risk.
Conclusions:
- Post-traumatic headache is a common occurrence in children following mild traumatic brain injury.
- Implementing protocolized follow-up and targeted history-taking for PTH in pediatric mTBI patients is recommended.
- This approach will facilitate accurate diagnosis and appropriate management of PTH in children discharged from emergency departments.
Objective:
To study the clinical profile and factors associated with post-traumatic headache (PTH) in children with mild traumatic brain injury (mTBI) attending an urban public hospital.
Methods:
We enrolled 130 consecutive children aged 6-12 years with mTBI (as per the International Classification of Headache Disorders-III criteria), and followed them up for 7 days. Those who developed PTH were further followed up monthly for 3 months.
Results:
Thirty (23.1%) children developed PTH; 25 (19.2%) children had acute PTH (duration 7 days to 3 months) and the remaining 5 (3.8%) developed persistent PTH (> 3 months). Majority (50%) had bilateral headache and squeezing quality (50%). Forty percent of those with PTH met the criteria for migraine. Obesity (P = 0.84), female gender (P = 0.26), family history of headache (P = 0.93), and prior history of concussion (P = 0.70) were not associated with risk of PTH. Children who developed PTH had higher rate of nausea (RR (95% CI) = 2.42 (1.06, 5.5); P = 0.03) and vomiting (RR (95% CI) = 3.76 (1.64, 8.5); P = 0.001) after mTBI. Headache resolved within 1 month in 63.3% of children.
Conclusion:
PTH was found to be common after mTBI in children. Protocolized follow-up and directed history taking for PTH in all children with mTBI, who are frequently discharge from the emergency department after first aid, will lead to appropriate diagnosis and management of this problem.
