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Acute and chronic management of posttraumatic headache in children: A systematic review
Carlyn Patterson Gentile1,2, Ryan Shah3, Samantha L Irwin4
1Pediatric Headache Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Insights
Evidence for treating pediatric posttraumatic headache (PTH) is limited. More research is needed on effective therapies and optimal timing for treating headaches after mild traumatic brain injury (mTBI) in children.
Area of Science:
- Pediatric neurology
- Neuroscience
- Traumatology
Background:
- Headache is a common symptom after mild traumatic brain injury (mTBI) in over 80% of children and adolescents.
- Optimal treatment strategies for pediatric posttraumatic headache (PTH) remain unclear, particularly regarding headache characteristics and chronicity.
Purpose of the Study:
- To compile and review the existing evidence for treating posttraumatic headache (PTH) in pediatric populations.
- To analyze the impact of headache features and therapy timing on treatment outcomes in youth.
Main Methods:
- Systematic literature searches were conducted across major databases (PubMed, Embase, Scopus, Cochrane) from 1985-2021.
- Included studies encompassed randomized controlled trials (RCTs), cohort studies, retrospective analyses, and case series involving participants under 18 with acute or persistent PTH.
- Studies reporting on headache improvement in response to various therapies were analyzed.
Main Results:
- Twenty-seven studies were included, covering pharmacologic therapies, neuromodulation, procedures, physical therapy, exercise, and behavioral therapy.
- Only five RCTs were identified; most studies focused on early (within 2 weeks) abortive therapies, while others examined longer-term outcomes.
- Limited data were available on migrainous features, personal migraine history, or family migraine history.
Conclusions:
- There is a significant lack of robust evidence regarding effective treatments and optimal timing for pediatric posttraumatic headache (PTH).
- Future research should prioritize prospective studies that incorporate detailed headache characteristics and standardized outcome measurements to guide therapy decisions.
Objectives:
The goal of this paper is to provide a compilation of the evidence for the treatment of posttraumatic headache (PTH) in the pediatric population. Headache features and timing of therapy were considered.
Background:
Headache is the most common symptom following mild traumatic brain injury (mTBI), affecting more than 80% of children and adolescents. It is unclear whether treatment for PTH should be tailored based on headache characteristics, particularly the presence of migraine features, and/or chronicity of the headache.
Methods:
Systematic literature searches of PubMed, Embase, Scopus, and Cochrane databases (1985-2021, limited to English) were performed, and key characteristics of included studies were entered into RedCAP® (Prospero ID CRD42020198703). Articles and conference abstracts that described randomized controlled trials (RCTs), cohort studies, retrospective analyses, and case series were included. Participants included youth under 18 years of age with acute (<3 months) and persistent (≥3 months) PTH. Studies that commented on headache improvement in response to therapy were included.
Results:
Twenty-seven unique studies met criteria for inclusion describing abortive pharmacologic therapies (9), preventative pharmacotherapies (5), neuromodulation (1), procedures (5), physical therapy and exercise (6), and behavioral therapy (2). Five RCTs were identified. Studies that focused on abortive pharmacotherapies were completed in the first 2 weeks post-mTBI, whereas other treatment modalities focused on outcomes 1 month to over 1-year post-injury. Few studies reported on migrainous features (7), personal history of migraine (7), or family history of migraine (3).
Conclusions:
There is limited evidence on the timing and types of therapies that are effective for treating PTH in the pediatric population. Prospective studies that account for headache characteristics and thoughtfully address the timing of therapies and outcome measurement are needed.
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