Advertisement

Demographics and Treatment of Adolescent Posttraumatic Headache in a Regional Concussion Clinic

      Abstract

      Objective

      Mild traumatic brain injury affects over one million pediatric patients annually. Minimal data and no guidelines exist regarding treatment of posttraumatic headache (PTH). The current study investigated treatment and outcomes in patients with posttraumatic headache.

      Methods

      Medical records of all patients (age 13-18 years of age) seen at a regional concussion program from 2006 to 2011 were reviewed. Statistical analysis using SAS 9.2 was conducted to determine the effectiveness of treatment as well as the association of gender, concussion history, and football participation on the duration of posttraumatic headache.

      Results

      Four hundred subjects met the inclusion criteria. Females were more likely to report posttraumatic headache than males (90% vs. 79%, P = 0.004), more likely to be prescribed amitriptyline (24% vs. 13%, P = 0.004), and had a significantly longer recovery time (median, 80 days versus 34 days, P < 0.001). Seventeen percent of subjects were prescribed amitriptyline for treatment of posttraumatic headache, of which 82% reported a beneficial effect. There was no difference in the percentage of posttraumatic headache or recovery time in football players versus other male athletes from other sport mechanisms.

      Conclusion

      Females are more likely to report posttraumatic headache than males and also take longer to recover. Amitriptyline appears to be well-tolerated and an effective treatment strategy for patients with posttraumatic headache. Among pediatric patients evaluated in a concussion clinic, there is no difference in the proportion of football players reporting headaches compared with male players of other sports.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Pediatric Neurology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Guskiewicz K.M.
        • McCrea M.
        • Marshall S.W.
        • et al.
        Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study.
        JAMA. 2003; 290: 2549-2555
        • Langlois J.A.
        • Rutland-Brown W.
        • Wald M.M.
        The epidemiology and impact of traumatic brain injury: a brief overview.
        J Head Trauma Rehabil. 2006; 21: 375-378
        • Lincoln A.E.
        • Caswell S.V.
        • Almquist J.L.
        • Dunn R.E.
        • Norris J.B.
        • Hinton R.Y.
        Trends in concussion incidence in high school sports: a prospective 11-year study.
        Am J Sports Med. 2011; 39: 958-963
        • Guerriero R.M.
        • Proctor M.R.
        • Mannix R.
        • Meehan 3rd, W.P.
        Epidemiology, trends, assessment and management of sport-related concussion in United States high schools.
        Curr Opin Pediatr. 2012; 24: 696-701
        • Marar M.
        • McIlvain N.M.
        • Fields S.K.
        • Comstock R.D.
        Epidemiology of concussions among United States high school athletes in 20 sports.
        Am J Sports Med. 2012; 40: 747-755
        • Gessel L.M.
        • Fields S.K.
        • Collins C.L.
        • Dick R.W.
        • Comstock R.D.
        Concussions among United States high school and collegiate athletes.
        J Athl Train. 2007; 42: 495-503
        • Seifert T.D.
        Sports concussion and associated post-traumatic headache.
        Headache. 2013; 53: 726-736
        • McCrory P.
        • Meeuwisse W.
        • Aubry M.
        • et al.
        Consensus statement on concussion in sport–the 4th International Conference on Concussion in Sport held in Zurich, November 2012.
        Clin J Sport Med. 2013; 23: 89-117
        • Mayer A.R.
        • Ling J.M.
        • Yang Z.
        • Pena A.
        • Yeo R.A.
        • Klimaj S.
        Diffusion abnormalities in pediatric mild traumatic brain injury.
        J Neurosc. 2012; 32: 17961-17969
        • Covassin T.
        • Swanik C.B.
        • Sachs M.L.
        Sex Differences and the Incidence of Concussions Among Collegiate Athletes.
        J Athl Train. 2003; 38: 238-244
        • Dick R.W.
        Is there a gender difference in concussion incidence and outcomes?.
        Br J Sports Med. 2009; 43: i46-i50
        • Colvin A.C.
        • Mullen J.
        • Lovell M.R.
        • West R.V.
        • Collins M.W.
        • Groh M.
        The role of concussion history and gender in recovery from soccer-related concussion.
        Am J Sports Med. 2009; 37: 1699-1704
        • Broshek D.K.
        • Kaushik T.
        • Freeman J.R.
        • Erlanger D.
        • Webbe F.
        • Barth J.T.
        Sex differences in outcome following sports-related concussion.
        J Neurosurg. 2005; 102: 856-863
        • Covassin T.
        • Swanik C.B.
        • Sachs M.
        • et al.
        Sex differences in baseline neuropsychological function and concussion symptoms of collegiate athletes.
        Br J Sports Med. 2006; 40 (discussion 927): 923-927
        • Headache Classification Committee of the International Headache S
        The International Classification of Headache Disorders, 3rd edition (beta version).
        Cephalalgia. 2013; 33: 629-808
        • Meehan 3rd, W.P.
        Medical therapies for concussion.
        Clin Sports Med. 2011; 30: 115-124, ix
        • Seifert T.D.
        • Evans R.W.
        Posttraumatic headache: a review.
        Curr Pain Headache Rep. 2010; 14: 292-298
        • Gladstone J.
        From psychoneurosis to ICHD-2: an overview of the state of the art in post-traumatic headache.
        Headache. 2009; 49: 1097-1111
        • Kontos A.P.
        • Elbin R.J.
        • Fazio-Sumrock V.C.
        • et al.
        Incidence of Sports-Related Concussion among Youth Football Players Aged 8-12 Years.
        J Pediatr. 2013; 163: 717-720
        • Giza C.C.
        • Kutcher J.S.
        • Ashwal S.
        • et al.
        Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology.
        Neurology. 2013; 80: 2250-2257
        • Harmon K.G.
        • Drezner J.A.
        • Gammons M.
        • et al.
        American Medical Society for Sports Medicine position statement: concussion in sport.
        Br J Sports Med. 2013; 47: 15-26
        • McCrory P.
        • Meeuwisse W.H.
        • Aubry M.
        • et al.
        Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012.
        Br J Sports Med. 2013; 47: 250-258
        • Kinart C.M.
        • Cuppett M.M.
        • Berg K.
        Prevalence of migraines in NCAA division I male and female basketball players. National Collegiate Athletic Association.
        Headache. 2002; 42: 620-629
        • Lipton R.B.
        • Pan J.
        Is migraine a progressive brain disease?.
        JAMA. 2004; 291: 493-494
        • Gordon K.E.
        • Dooley J.M.
        • Wood E.P.
        Is migraine a risk factor for the development of concussion?.
        Br J Sports Med. 2006; 40: 184-185
        • Haas D.C.
        Chronic post-traumatic headaches classified and compared with natural headaches.
        Cephalalgia. 1996; 16: 486-493
        • Baandrup L.
        • Jensen R.
        Chronic post-traumatic headache–a clinical analysis in relation to the International Headache Classification 2nd Edition.
        Cephalalgia. 2005; 25: 132-138
        • Bettucci D.
        • Aguggia M.
        • Bolamperti L.
        • Riccio A.
        • Mutani R.
        Chronic post-traumatic headache associated with minor cranial trauma: a description of cephalalgic patterns.
        Ital J Neurol Sci. 1998; 19: 20-24
        • Bekkelund S.I.
        • Salvesen R.
        Prevalence of head trauma in patients with difficult headache: the North Norway Headache Study.
        Headache. 2003; 43: 59-62
        • Weiss H.D.
        • Stern B.J.
        • Goldberg J.
        Post-traumatic migraine: chronic migraine precipitated by minor head or neck trauma.
        Headache. 1991; 31: 451-456
        • Headache Classification Subcommittee of the International Headache S
        The International Classification of Headache Disorders: 2nd edition.
        Cephalalgia. 2004; 24: 9-160
        • Scher A.I.
        • Monteith T.S.
        Epidemiology and classification of post-traumatic headache: What do we know and how do we move forward? Comment on Lucas et al., “Prevalence and characterization of headache following mild TBI”.
        Cephalalgia. 2014; 34: 83-85
        • Tierney R.T.
        • Sitler M.R.
        • Swanik C.B.
        • Swanik K.A.
        • Higgins M.
        • Torg J.
        Gender differences in head-neck segment dynamic stabilization during head acceleration.
        Med Sci Sports Exer. 2005; 37: 272-279
        • Esposito G.
        • Van Horn J.D.
        • Weinberger D.R.
        • Berman K.F.
        Gender differences in cerebral blood flow as a function of cognitive state with PET.
        J Nucl Med. 1996; 37: 559-564
        • Gioia G.A.
        • Collins M.
        • Isquith P.K.
        Improving identification and diagnosis of mild traumatic brain injury with evidence: psychometric support for the acute concussion evaluation.
        J Head Trauma Rehabil. 2008; 23: 230-242
        • Blume H.K.
        • Vavilala M.S.
        • Jaffe K.M.
        • et al.
        Headache after pediatric traumatic brain injury: a cohort study.
        Pediatrics. 2012; 129: e31-39
        • Packard R.C.
        • Ham L.P.
        Pathogenesis of posttraumatic headache and migraine: a common headache pathway?.
        Headache. 1997; 37: 142-152
        • Packard R.C.
        Epidemiology and pathogenesis of posttraumatic headache.
        J Head Trauma Rehabil. 1999; 14: 9-21
        • Barlow K.M.
        Postconcussion Syndrome: A Review.
        J Child Neurol. 2014;
        • Heyer G.L.
        • Rose S.C.
        • Merison K.
        • Perkins S.Q.
        • Lee J.E.
        Specific headache factors predict sleep disturbances among youth with migraine.
        Pediatr Neurol. 2014; 51: 489-493
        • Ferrari R.
        • Constantoyannis C.
        • Papadakis N.
        Cross-cultural study of symptom expectation following minor head injury in Canada and Greece.
        Clin Neurol Neurosurg. 2001; 103: 254-259
        • Ferrari R.
        • Obelieniene D.
        • Russell A.S.
        • Darlington P.
        • Gervais R.
        • Green P.
        Symptom expectation after minor head injury. A comparative study between Canada and Lithuania.
        Clin Neurol Neurosurg. 2001; 103: 184-190
        • Silberstein S.D.
        Preventive treatment of migraine.
        Trends Pharmacol Sci. 2006; 27: 410-415
        • Kuczynski A.
        • Crawford S.
        • Bodell L.
        • Dewey D.
        • Barlow K.M.
        Characteristics of post-traumatic headaches in children following mild traumatic brain injury and their response to treatment: a prospective cohort.
        Dev Med Child Neurol. 2013; 55: 636-641
        • Moore R.A.
        • Derry S.
        • Aldington D.
        • Cole P.
        • Wiffen P.J.
        Amitriptyline for neuropathic pain and fibromyalgia in adults.
        Cochrane Database Syst Rev. 2012; 12: CD008242
        • Thanacoody H.K.
        • Thomas S.H.
        Tricyclic antidepressant poisoning : cardiovascular toxicity.
        Toxicol Rev. 2005; 24: 205-214
        • Montgomery S.A.
        Suicide and antidepressants.
        Ann N Y Acad Sci. 1997; 836: 329-338
        • Guskiewicz K.M.
        • Marshall S.W.
        • Bailes J.
        • et al.
        Association between recurrent concussion and late-life cognitive impairment in retired professional football players.
        Neurosurgery. 2005; 57 (discussion 719-726): 719-726
        • Gavett B.E.
        • Stern R.A.
        • Cantu R.C.
        • Nowinski C.J.
        • McKee A.C.
        Mild traumatic brain injury: a risk factor for neurodegeneration.
        Alzheimers Res Ther. 2010; 2: 18