Background: Evidence for effective interventions to prevent long-term sequelae after concussion is sparse. This study aimed to test the efficacy of Get going After concussIoN (GAIN), an interdisciplinary, individuallytailored intervention of 8 weeks duration based on gradual return to activities and principles from cognitive behavioural therapy. Methods: We conducted an open-label, parallel-group randomised trial in a hospital setting in Central Denmark Region. Participants were 15À30-year-old patients with high levels of post-concussion symptoms (PCS) 2À6 months post-concussion (i.e., a score 20 on the Rivermead Post-concussion Symptoms Questionnaire (RPQ)). They were randomly assigned (1:1) to either enhanced usual care (EUC) or GAIN+EUC. Masking of participants and therapists was not possible. The primary outcome was change in RPQ-score from baseline to 3-month FU. All analyses were done on an intention-to-treat basis using linear mixed-effects models. This trial is registered with ClinicalTrials.gov, number NCT02337101. Findings: Between March 1, 2015, and September 1, 2017, we included 112 patients. Patients allocated to GAIN+EUC (n=57) reported a significantly larger reduction of PCS than patients allocated to EUC (n=55) with a mean adjusted difference in improvement of 7¢6 points (95% confidence interval (CI) 2¢0À13¢1, p=0¢008), Cohen's d=0¢5 (95% CI 0¢1À0¢9). Number needed to treat for prevention of one additional patient with RPQ 20 at 3-month FU was 3¢6 (95% CI 2¢2À11¢3). No adverse events were observed. Interpretation: Compared with EUC, GAIN+EUC was associated with a larger reduction of post-concussion symptoms at 3-month FU. Funding: Central Denmark Region and the foundation "Public Health in Central Denmark Region-a collaboration between municipalities and the region".

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The new early intervention is feasible and may prevent chronification of PCS. An RCT is currently performed to evaluate the effect of the intervention.

Characteristics of persistent post-traumatic headache (PTH) in young individuals are poorly known leading to diagnostic problems and diverse management. We aimed to describe headache phenotypes and self-reported management strategies in young individuals with PTH following mild traumatic brain injury (mTBI). A comprehensive structured questionnaire was used to evaluate headache phenotypes/characteristics and management strategies to relieve headache in 107, 15–30-year-old individuals with PTH. Around 4 months post-injury, migraine-like headache in combination with tension-type like headache (40%) was the most commonly encountered headache phenotype followed by migraine-like headache (36%). Around 50% reported aura-like symptoms before/during the headache attack. Medication-overuse headache was diagnosed in 10%. Stress, sleep disturbances, and bright lights were the most common trigger factors. More than 80% reported that their headache was worsened by work-related activity and alleviated by rest/lying down. Simple analgesics were commonly used (88%) whereas prophylactic drugs were rarely used (5%). Bedrest and physiotherapy were also commonly used as management strategies by 56% and 34% of the participants, respectively. In conclusion, most young individuals with PTH after mTBI presented with combined migraine-like and tension-type-like headache followed by migraine-like headache, only. Preventive headache medication was rarely used, while simple analgesics and bedrest were commonly used for short-term headache relief.

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Background Pain is a primary symptom in juvenile idiopathic arthritis (JIA), and we have previously shown that children with JIA have a decreased pain threshold when compared with healthy age-related children. The reason for this, however, remains uncertain. Biological as well as psychological factors may be influential. The association between pain and coping strategies is well known and well documented. It is important to clarify the effect of coping strategies on pain threshold among children with JIA in order to better target pain treatment of these children. Objectives To assess the pressure pain threshold and pain coping strategies of children with JIA compared with a healthy control group. We also aim to assess any association between pressure pain threshold and pain coping strategies among children with JIA. Methods We included 58 children with JIA born 1995 to 2000 admitted to the pediatric rheumatology clinic. Ninety-one age-related healthy school children served as a control group. All children were asked to complete a subscale of the Pain Coping Questionnaire. Afterwards, pain threshold was measured using a digital pressure algometer on 17 symmetric, anatomically predefined joint or bone-related points. Results Children with JIA were less likely to use positive self-statements (t: -2.85, p=0.005, Cohen’s d = -0.48) as well as cognitive and behavioral distraction (t: -3.81, p<0.001, Cohen’s d = -0.63, and t: -2.71, p=0.008, Cohen’s d = -0.46, respectively). They used significantly more internalizing/catastrophizing coping strategies when compared with children in the healthy control group (t: 2.22, p=0.028, Cohen’s d =0.38). However, we found no correlation between pain threshold and any of the pain coping strategies among the children with JIA (p=0.138-0.608, r =0.07-0.20). The pain threshold was significantly lower among children with JIA (total mean PT =1.33±0.69 kg/cm2) when compared with the healthy control group (total mean PT =1.77±0.67 kg/cm2). The same pattern was found in all areas measured (p<0.001-0.005). Conclusions Although children with JIA seem to differ from healthy children with regard to their pressure pain threshold as well as to their pain coping strategies, the lack of association between the two outcomes suggests that the enhanced use of mal-adaptive pain coping strategies cannot explain the decreased pressure pain threshold of children with JIA in our study. Other factors such as sensitization may be influential, but further studies in this area are needed. Disclosure of Interest None Declared

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