Early analgesic administration and headache presence 7 days post-concussion in children
Andrée -Anne Ledoux1,2, Ken Tang3, Stephen B Freedman4
1Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada. aledoux@cheo.on.ca.
Insights
Acute ibuprofen or acetaminophen did not reduce headache risk 7 days post-concussion in children. Clinicians should monitor for medication overuse in persistent headache cases.
Area of Science:
- Pediatric neurology
- Clinical pharmacology
- Public health
Background:
- Headache is a common post-concussion symptom in children and youth.
- The efficacy of acute analgesic treatment for persistent headaches after concussion is not well-established.
Purpose of the Study:
- To determine if acute treatment with ibuprofen, acetaminophen, or both impacts headache resolution at 7 days post-concussion.
- To analyze the association between analgesic use and headache presence 7 days after concussion in pediatric patients.
Main Methods:
- Secondary analysis of the Predicting and Preventing Post-concussive Problems in Pediatrics (5P) cohort study.
- Involved 3063 children and youth (aged 5-18) with acute concussion.
- Used propensity scores and adjusted multivariate regression to assess the association between acute analgesic administration and headache at 7 days.
Main Results:
- Of 3063 participants, 2277 had headache upon presentation; 1543 received analgesics.
- Among 1707 participants analyzed, 877 (51.4%) reported headache at 7 days.
- No significant association was found between ibuprofen, acetaminophen, or both, and the presence of headache at 7 days post-concussion.
Conclusions:
- Acute administration of ibuprofen, acetaminophen, or both does not decrease the risk of headache 7 days after concussion.
- While these analgesics may offer short-term relief, caution is advised regarding long-term medication overuse for persistent post-concussion headaches.
Objective:
This study investigates whether acute treatment with ibuprofen, acetaminophen, or both is associated with resolution of headache or reduction of headache pain at 7 days post-concussion in children and youth.
Methods:
A secondary analysis of the Predicting and Preventing Post-concussive Problems in Pediatrics (5P) prospective cohort study was conducted. Individuals aged 5-18 years with acute concussion presenting to nine Canadian pediatric emergency departments (ED) were enrolled from August 2013 to June 2015. The primary outcome was the presence of headache at 7 days, measured using the Post-Concussion Symptom Inventory. The association between acute administration of ibuprofen, acetaminophen, or both and headache presence at 7 days was investigated with propensity scores and adjusted multivariate regression models.
Results:
2277 (74.3%) of 3063 participants had headache upon ED presentation. Of these participants, 1543 (67.8%) received an analgesic medication before or during their ED visit [ibuprofen 754 (33.1%), acetaminophen 445 (19.5%), both 344 (15.1%); or no medication 734 (32.2%)]. Multivariate analysis pertained to 1707 participants with propensity scores based on personal characteristics and symptoms; 877 (51.4%) reported headache at 7 days post-concussion. No association emerged between treatment and presence of headache at 7 days [ibuprofen vs. untreated: (relative risk (RR) = 1.12 (95% CI 0.99,1.26); acetaminophen vs untreated RR = 1.02 (95% CI 0.87,1.22); both vs untreated RR = 1.02 (95% CI 0.86,1.18)].
Conclusions:
Exposure to ibuprofen, acetaminophen, or both in the acute phase does not decrease the risk of headache at 7 days post-concussion. Non-opioid analgesics like ibuprofen or acetaminophen may be prescribed for short-term headache relief but clinicians need to be cautious with long-term medication overuse in those whose headache symptoms persist.
