Efficacy of outpatient infusion therapy in pediatric patients with postconcussive headaches
James Pate1, James Mooney2, Erin Katz1
1School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Insights
Intravenous therapy for pediatric postconcussive headaches showed similar effectiveness to oral treatments in reducing headache and symptom severity scores. Both methods provided significant relief, indicating comparable efficacy in managing these common symptoms.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Pharmacology
Background:
- Postconcussive headaches are a common sequela of mild traumatic brain injury in children.
- Current treatment options primarily involve oral medications, which may have limitations in rapid symptom relief.
Purpose of the Study:
- To compare the efficacy of intravenous (IV) infusion therapy versus oral therapy for managing postconcussive headaches in pediatric patients.
- To evaluate the impact of IV therapy on headache score (HA) and symptom severity score (SSS).
Main Methods:
- Retrospective chart review of 53 pediatric patients treated for postconcussive headaches at an outpatient infusion clinic.
- Comparison of HA and SSS changes before and after IV infusion therapy against an age- and SSS-matched control group receiving oral therapy.
- IV infusion included ketorolac, compazine, diphenhydramine, and normal saline.
Main Results:
- Both IV infusion therapy and oral therapy resulted in statistically significant reductions in mean HA and SSS scores (p < 0.0001).
- No statistically significant difference was observed in the reduction of symptom scores between the IV infusion and oral therapy groups.
- IV therapy may offer faster headache relief based on pharmacokinetic profiles.
Conclusions:
- Intravenous infusion therapy demonstrates comparable efficacy to oral therapies in reducing postconcussive headache severity in pediatric patients.
- IV therapy may provide a faster onset of headache relief and potentially facilitate a quicker return to play for athletes.
- Further research is warranted to explore the comparative time to symptom resolution and return-to-play outcomes.
Purpose:
To determine the relative efficacy of intravenous therapy for postconcussive headaches in a pediatric population, as compared to oral therapy.
Methods:
Pediatric patients treated for postconcussive headaches at an outpatient infusion clinic from 2016 to 2018 were selected for inclusion in the study. Of the 95 patients who were treated in clinic, 53 patients were selected for a retrospective chart review. Clinic visits before and after infusions were reviewed to determine changes in headache score (HA), symptom severity score (SSS), and self-reported symptom relief. An age-matched and SSS-matched group served as a control. The control group received only oral therapy for their headaches. The infusion consisted of parenteral ketorolac, compazine, diphenhydramine, and a normal saline bolus (20 mg/kg).
Results:
Following infusion therapy, overall mean HA and SSS scores were both reduced (p < 0.0001). Oral therapy demonstrated a similar mean overall reduction in HA and SS scores (p < 0.0001). While both groups achieved a reduction in HA and SS scores, there was not a statistically significant difference in reduction of symptoms scores between the oral and infusion groups.
Conclusion:
Infusion therapy is as effective at reducing HA and SSS as established oral therapies. Infusion therapy may have a shorter time to headache abortion than oral therapy based on pharmacokinetics. Further, some physicians are unwilling to allow an athlete to return to play while taking suppressive medication. Future studies may show that an infusion could allow a more rapid return to play and resolution of symptoms.
