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Post-traumatic headache pathophysiology in paediatric concussion: A systematic review
Feiven Fan1, Vicki Anderson2, Thilanka Morawakage3
1Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia.
Insights
The causes of post-traumatic headache (PTH) after concussion in children are not well understood. Current research quality is low, highlighting the need for better studies on pediatric concussion headache mechanisms.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Concussion Research
Background:
- Post-traumatic headache (PTH) is the most frequent symptom following pediatric concussion.
- The underlying pathophysiology of PTH in children remains largely unknown.
- Understanding PTH mechanisms is critical for effective management and treatment.
Approach:
- A systematic review of 19 studies involving 1214 pediatric concussion participants was conducted.
- The review examined evidence on PTH pathophysiology, including cerebrovascular function, white matter integrity, functional connectivity, electrophysiology, neurometabolics, biological markers, and vestibular/oculomotor function.
- Study quality and risk of bias were assessed according to PRISMA guidelines.
Key Points:
- The majority of included studies (90%) were rated as fair quality, with 84% providing Level 3 evidence.
- Evidence regarding specific pathophysiological mechanisms of PTH in pediatric concussion is scarce and lacks specificity.
- Current research is insufficient to elucidate the true underlying mechanisms of PTH.
Conclusions:
- The pathophysiology of post-traumatic headache following pediatric concussion remains unclear.
- The overall quality of evidence is weak, characterized by fair risk of bias.
- Future research must rigorously isolate PTH-specific pathophysiology using standardized definitions and measurement tools.
Abstract:
Post-traumatic headache (PTH) represents the most common acute and persistent symptom following concussion in children, yet the underlying pathophysiology remains unclear. This systematic review sought to: (i) rigorously examine the current evidence of PTH pathophysiology in paediatric concussion (0-18 years), (ii) assess the quality of evidence, and (iii) provide directions for future research in accordance with PRISMA guidelines. Eligible studies (n = 19) totalling 1214 concussion participants investigated cerebrovascular function (n = 6), white matter integrity (n = 3), functional connectivity (n = 3), electrophysiology (n = 1), neurometabolics (n = 2), biological fluid markers (n = 4), vestibular and oculomotor function (n = 4); two studies used a multi-modal approach. Majority of studies were rated as fair quality (90%) and Level 3 evidence (84%). The true underlying mechanisms of PTH following paediatric concussion remain unclear. Overall quality of the available evidence is generally weak with a fair risk of bias and characterised by relative scarcity and lack of specificity of PTH pathophysiology. Future research is required to rigorously isolate pathophysiology specific to PTH with strict adherence to clinical definitions and standardised measurement tools of PTH.
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