Acute and chronic management of posttraumatic headache in children: A systematic review

Abstract

Objectives The goal of this paper is to provide a compilation of the evidence for the treatment of posttraumatic headache (PTH) in the pediatric population. Headache features and timing of therapy were considered. Background Headache is the most common symptom following mild traumatic brain injury (mTBI), affecting more than 80% of children and adolescents. It is unclear whether treatment for PTH should be tailored based on headache characteristics, particularly the presence of migraine features, and/or chronicity of the headache. Methods Systematic literature searches of PubMed, Embase, Scopus, and Cochrane databases (1985–2021, limited to English) were performed, and key characteristics of included studies were entered into RedCAP® (Prospero ID CRD42020198703). Articles and conference abstracts that described randomized controlled trials (RCTs), cohort studies, retrospective analyses, and case series were included. Participants included youth under 18 years of age with acute (<3 months) and persistent (≥3 months) PTH. Studies that commented on headache improvement in response to therapy were included. Results Twenty‐seven unique studies met criteria for inclusion describing abortive pharmacologic therapies (9), preventative pharmacotherapies (5), neuromodulation (1), procedures (5), physical therapy and exercise (6), and behavioral therapy (2). Five RCTs were identified. Studies that focused on abortive pharmacotherapies were completed in the first 2 weeks post‐mTBI, whereas other treatment modalities focused on outcomes 1 month to over 1‐year post‐injury. Few studies reported on migrainous features (7), personal history of migraine (7), or family history of migraine (3). Conclusions There is limited evidence on the timing and types of therapies that are effective for treating PTH in the pediatric population. Prospective studies that account for headache characteristics and thoughtfully address the timing of therapies and outcome measurement are needed.

Comparison of continuous headache features in youth with migraine, new daily persistent headache, and persistent post-traumatic headache

“…More treatment options are available for migraine (23) than NDPH and PPTH in youth. Our findings indicate that the majority of individuals with NDPH and PPTH cannot be distinguished from those with migraine based on clinical features, and expert opinion suggests that headache management in NDPH and PPTH should be based on the headache disorder clinical features most resemble (19,24,25).…”

Association of Posttraumatic Headache With Symptom Burden After Concussion in Children

“…Multidisciplinary management of postconcussion symptoms often includes pharmacological intervention, physical and vestibular rehabilitation, subsymptom threshold aerobic exercise, and cognitive behavioral therapy, with varying effectiveness. However, limited evidence is available regarding the efficacy of pediatric PTH management . Our results suggest clinical management should target early intervention for children with migraine symptoms to reduce the risk of prolonged symptom burden.…”

“…Our results suggest clinical management should target early intervention for children with migraine symptoms to reduce the risk of prolonged symptom burden. Further research to determine effective treatment strategies that consider headache phenotype is warranted …”

Virtual issue: Recent advances in pediatric headache: Bridging the data gap

“…Finally, this issue contains comprehensive reviews of cyclic vomiting syndrome 13 and posttraumatic headache, 14 conditions commonly encountered in both general pediatric practices and subspecialty clinics. These reviews, along with the other manuscripts included in this virtual issue, aim to guide clinicians in their patient care, elucidate the underlying neurobiology of pediatric headache disorders, and identify areas of future research within the headache field.…”