MANAGEMENT OF CHRONIC
HEADACHES IN PEDIATRIC
POST-CONCUSSION
SYNDROME
Susan Beaird, DNP, CPNP
Lauren King, MSN, CPNP
Concussion Pathophysiology
Concussion
Initial injury
Secondary
Inflammation
Cell damage
Response to cell
damage
Increased metabolic
need
Decreased cerebral
perfusion
Kids > Adults
So Why Rest?

“Metabolic Mismatch”
Physical
Activity
Cognitive
Activity
Increased
metabolic
demand
Concussion vs. Postconcussion Syndrome


Concussion: symptoms ≤ 2 weeks
Postconcussion syndrome: symptoms ≥ 4 weeks
Physical
Emotional
Concussion
Sleep
Cognitive
Risk for Postconcussion Syndrome



Overexertion during recovery phase
Previous head injury
Comorbid conditions
 Primary
headache disorder
 Mood disorder
 ADD/ADHD

??
Management of Postconcussion
Syndrome


Time and Rest
Symptom management
 neurology
 School and learning issues  neuropsychology
 Dizziness and balance issues  vestibular rehabilitation
 Headaches
Headache Management in
Postconcussion Syndrome




Education and Expectations
Lifestyle
Nutraceuticals
Medications
 Acute
 Prophylactic
Conclusion
What we’ve learned



Common personality
traits
Family history of
“brain things”
You’ll need a box of
tissues
What we hope to learn

Predictive qualities
 Risk
 Recovery

Structured return to
activities for
postconcussion patients
Our Team
Pediatric Neurology


Lauren E. King, MSN, CPNP
Susan E. Beaird, DNP, CPNP
Pediatric Rehabilitation

R. Steven Couch, MD



Assistant professor of
pediatrics
Division of Developmental
Medicine
Associate medical director of
pediatric rehab at Vanderbilt
Stallworth Rehabilitation
Hospital