Posttraumatic headache and clinical recovery after pediatric concussion
Mica Gabrielle Marbil1,2, Jean-Michel Galarneau3, Keith Owen Yeates1,2,4
1Department of Psychology, University of Calgary, Calgary, AB, Canada.
Insights
Posttraumatic headache (PTH) onset in children after concussion is linked to more postconcussive symptoms (PCS) and poorer fluid cognition. However, pain intensity decreased over time for all headache types.
Area of Science:
- Pediatric neurology
- Traumatic brain injury research
- Pain medicine
Background:
- Pediatric concussion is a common injury with varied recovery trajectories.
- Posttraumatic headache (PTH) is a frequent complication, but its impact on recovery is not fully understood.
- Understanding the relationship between PTH types and outcomes is crucial for effective management.
Purpose of the Study:
- To investigate the association between different types of posttraumatic headache (PTH) and postconcussive symptoms (PCS), pain intensity, and fluid cognitive function in children recovering from concussion.
- To differentiate outcomes based on the presence and chronicity of PTH.
Main Methods:
- A prospective, longitudinal study followed children (8-16.99 years) with concussion or orthopedic injury (OI).
- Children were categorized into groups based on pre- and postinjury headache status: no PTH, new PTH, worse PTH, chronic PTH, and OI with no PTH.
- Postconcussive symptoms, pain intensity, and fluid cognitive function were assessed weekly for up to 6 months postinjury.
Main Results:
- Postconcussive symptoms were significantly higher in children with new, chronic, or worse PTH compared to those with no PTH or OI, particularly within the first 8 weeks postinjury.
- Fluid cognitive function remained lower over time in children with chronic PTH and new PTH compared to those with no PTH or OI.
- Pain intensity decreased over time across all groups, irrespective of PTH type.
Conclusions:
- The onset of PTH following pediatric concussion is associated with more severe postconcussive symptoms for up to 8 weeks.
- New and chronic PTH are linked to moderately impaired fluid cognitive functioning for up to 6 months post-injury.
- Pain management in pediatric concussion should consider the trajectory of headache development, though pain itself tends to resolve over time.
Objective:
To examine the association of posttraumatic headache (PTH) type with postconcussive symptoms (PCS), pain intensity, and fluid cognitive function across recovery after pediatric concussion.
Methods:
This prospective, longitudinal study recruited children (aged 8-16.99 years) within 24 hours of sustaining a concussion or mild orthopedic injury (OI) from two pediatric hospital emergency departments. Based on parent-proxy ratings of pre- and postinjury headache, children were classified as concussion with no PTH (n = 18), new PTH (n = 43), worse PTH (n = 58), or non-worsening chronic PTH (n = 19), and children with OI with no PTH (n = 58). Children and parents rated PCS and children rated pain intensity weekly up to 6 months. Children completed computerized testing of fluid cognition 10 days, 3 months, and 6- months postinjury. Mixed effects models compared groups across time on PCS, pain intensity, and cognition, controlling for preinjury scores and covariates.
Results:
Group differences in PCS decreased over time. Cognitive and somatic PCS were higher in new, chronic, and worse PTH relative to no PTH (up to 8 weeks postinjury; d = 0.34 to 0.87 when significant) and OI (up to 5 weeks postinjury; d = 0.30 to 1.28 when significant). Pain intensity did not differ by group but declined with time postinjury. Fluid cognition was lower across time in chronic PTH versus no PTH (d = -0.76) and OI (d = -0.61) and in new PTH versus no PTH (d = -0.51).
Conclusions:
Onset of PTH was associated with worse PCS up to 8 weeks after pediatric concussion. Chronic PTH and new PTH were associated with moderately poorer fluid cognitive functioning up to 6 months postinjury. Pain declined over time regardless of PTH type.
