Analgesic Overuse Contributes to Chronic Post-Traumatic Headaches in
Adolescent Concussion Patients
Heyer GL (Columbus, OH), Idris SA
Objective: Among a cohort of adolescents with chronic post-concussion headaches,
we sought to compare signs, symptoms, and outcomes of patients with medication
overuse to those without medication overuse.
Methods: A retrospective cohort review was conducted of adolescent concussion
patients referred to a pediatric headache clinic for chronic post-traumatic
headaches of 3–12 months duration. Concussion symptoms, headache symptoms
(pre- and post-concussion), demographic data, and headache outcomes were
compared between those with and those without probable medication-overuse
headache.
Results: Of 104 adolescent concussion patients referred, 77 had chronic posttraumatic headache of 3–12 months duration. Fifty four of 77 (70.1%) met criteria
for probable medication-overuse headache. Patients with medication overuse
were more likely to have daily headaches (p50.006), to be female (p50.02), to have
nausea (p<0.001) and/or throbbing (p50.001) associated with headaches, to have
had increased irritability following concussion (p50.03), and to have had a longer
interval between injury and neurology evaluation (p50.003). Of the patients with
medication overuse, 37 (68.5%) had resolution of headaches or improvements to
pre-concussion headache patterns after discontinuing analgesics, 7 (13%) had no
change in headaches or worsening of headaches after discontinuing analgesics, and
10 (18.5%) did not discontinue analgesics or were lost to follow up.
Conclusion: Excessive use of analgesics post-concussion may exacerbate or
chronify post-traumatic headaches in some adolescents. Analgesics should be
minimized or discontinued when headaches continue several weeks following
concussion.
Keywords: Headache/Migraine
Post Concussion Headache (PCHA) in Children and Adolescents (C&A)
A. Leubitz (Cleveland, OH), Rothner AD
Objective: To determine the feature of PCHA in C/A. 1.6 – 3.8 million concussions
occur annually. Many have PCHA. Details concerning types of HA, duration of
symptoms, imaging data, treatment and prognosis are needed.
Methods: We reviewed 67 cases of PCHA seen 2010–2012. Data regarding age, sex,
previous concussion, family history of HA, and concussion were collected.
Results: Our 67 patients were from a total of 675 New HA patients seen during the
same time. 39 were males, sports were football, hockey, lacrosse and falls. In 28/64
the HA was immediate, in others it started after days or weeks. Types of HA:
episodic TTH, chronic daily headache with superimposed migraine. Pure episodic
migraine was rare. Imaging was negative in all save 3 who showed abnormalities
unrelated to the HA or injury. Concussion symptoms included headache, dizziness,
irritability, anxiety, depression, photophobia and memory and concentration
impairment. School issues were prominent. This OPD sample demonstrates
that HA following head injuries are common. Even mild concussions may result in
prolonged HA which interfere with school function. Data regarding management in
the first 6 weeks is lacking. If the HA has been present for>6 weeks, education,
judicious use of rescue medication, preventive medication, psychosocial support
and lifestyle approaches are useful. The prognosis is guarded and many HA last>1
yr.
Conclusion: Additional prospective date regarding PCHA in C/A is needed.
Agreement regarding management of these patients is lacking.
Keywords: Headache/Migraine
Risk Factors for the Development of Headache after Traumatic Brain Injury in
a Pediatric Subspecialty Clinic Population.
Choe MC (Los Angeles, CA), Fischer JT, Yudovin S, McArthur
DL, Asarnow R, Giza CC
Objective: Traumatic brain injury (TBI) is a major pediatric public health problem,
with as many as 500,000 children under the age of 15 presenting to emergency
departments annually. The most prevalent and debilitating posttraumatic symptom
is headache. Post-traumatic headache (PTHA) can lead to poor school performance,
disruption in social function, and familial hardships. This study was conducted
to further understand the factors that contribute to development of PTHA in a
pediatric subspecialty population.
Methods: Data was prospectively collected from individuals 5–22 years of age
presenting to clinic with TBI. 172 patients had 6 month follow-up after injury.
Results: 136 patients (119 males, 54 females) had mild injuries and 36 patients had
moderate or severe injuries. 2/3of patients presented with PTHA. PTHA was 5 times
more likely amongst those patients with mild injuries. Patients who presented with
PTHA were 2.70 times more likely to have had a prior TBI (C.I. 1.35-5.64), and a
premorbid history of headache (C.I 1.62-16.00). Patients with PTHA were also 2.21
times more likely to present with comorbid psychiatric or cognitive complaints (C.I.
1.12-4.57). Female patients were almost 4 times more likely to have PTHA
(C.I. 1.80-9.90) and more than 21=2 times more likely to have suffered a mild injury
(C.I. 1.06–7.37). Statistical analysis was performed using EpiTools: R Package (v0.5–
6).
Conclusions: Careful risk factor assessment may help to identify patients more likely
to develop persistent PTHA who would benefit from early pediatric neurology clinic
referral and intervention.
Sources of Funding: We acknowledge support from UCLA BIRC, NS05489,
HD061504,Morris A. Hazan Friends of Semel Fellowship, Child Neurology
Foundation/Winokur Family Foundation, Today’s and Tomorrow’s Children Fund.
Keywords: Headache/Migratine