Survey of Child Neurologists on Management of Pediatric Post-traumatic Headache

Pearson, Rachel; Desiree, Levyim; Choe, Meeryo; Taraman, Sharief; Langdon, Raquel

doi:10.1177/0883073819856837

Cited by 12 publications

(9 citation statements)

References 40 publications

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“…This is consistent with a survey of pediatric PTH treatment that found most clinicians would wait 4 weeks or more after injury to start preventive medications. 25 Both the survey and this study found that the most popular prescription medications were tricyclic antidepressants, despite the facts that amitriptyline was not Downloaded From: https://jamanetwork.com/ on 03/15/2021 superior to placebo for pediatric migraine prevention 9 and may cause significant adverse effects.…”

Section: Discussionmentioning

confidence: 66%

Evaluation of Posttraumatic Headache Phenotype and Recovery Time After Youth Concussion

et al. 2021

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IMPORTANCE The Four Corners Youth Consortium was created to fill the gap in our understanding of youth concussion. This study is the first analysis of posttraumatic headache (PTH) phenotype and prognosis in this cohort of concussed youth. OBJECTIVE To describe the characteristics of youth with PTH and determine whether the PTH phenotype is associated with outcome. DESIGN, SETTING, AND PARTICIPANTS This cohort study examined outcomes from patients in a multi-institutional registry of traumatic brain injury (TBI) clinics from December 2017 to June 2019. Inclusion criteria included being between ages 5 and 18 years at enrollment and presentation within 8 weeks of a mild TBI. Data were analyzed between February 2019 and January 2021. EXPOSURE Mild TBI with standard care. MAIN OUTCOMES AND MEASURES Time to recovery and headache 3 months after injury; measurement device is the Postconcussion Symptom Inventory (PCSI). PTH with migraine phenotype was defined as moderate-severe headache that is new or significantly worse compared with baseline and associated with nausea and/or photophobia and phonophobia. RESULTS A total of 612 patients with 625 concussions were enrolled, of whom 387 patients with 395 concussions consented to participate in this study. One hundred nine concussions were excluded (concussions, rather than patients, were the unit of analysis), leaving 281 participants with 286 concussions (168 [58.7%] girls; 195 [75.6%] White; 238 [83.2%] aged 13-18 years). At the initial visit, 133 concussions (46.5%) were from patients experiencing PTH with a migraine phenotype, 57 (20%) were from patients experiencing PTH with a nonmigraine phenotype, and 96 (34%) were from patients with no PTH. Patients with any PTH after concussion were more likely to have prolonged recovery than those without PTH (median [interquartile range], 89 [48-165] days vs 44 [26-96] days; log-rank P < .001). Patients with PTH and a migraine phenotype took significantly longer to recover than those with nonmigraine phenotype (median [interquartile range], 95 [54-195] days vs 70 [46-119] days; log-rank P = .01). Within each phenotype, there was no significant difference between sexes in recovery or PTH at 3 months.

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Section: Discussionmentioning

confidence: 66%

Evaluation of Posttraumatic Headache Phenotype and Recovery Time After Youth Concussion

et al. 2021

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“…35 The proper identification of posttraumatic headache and related symptoms may influence the treatments chosen for headache, which may include both abortive and prophylactic medications. 36 Other targeted therapies toward posttraumatic headache are based on contributors to headache provocation and include exercise, cervical physical therapy, and vestibular therapy. 37 The aggregation of symptoms of difficulty remembering, confusion, and difficulty concentrating into a Cognitive factor with the symptom of difficulty remembering as the greatest contributor highlights the need to address these cognitive factors in this student-athlete population.…”

Section: Discussionmentioning

confidence: 99%

Factor Structure for the Sport Concussion Assessment Tool Symptom Scale in Adolescents After Concussion

Alsalaheen

Almeida

et al. 2021

Clinical Journal of Sport Medicine

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Objective:To examine the factor structure of the Sport Concussion Assessment Tool-5 (SCAT5) symptom scale in adolescents on their initial presentation to a concussion clinic within the typical recovery period after concussion (ie, <30 days). We hypothesize that the SCAT5 symptoms represent various clinically meaningful groups. A secondary purpose was to examine the effects of sex on the factor structure of the SCAT5 symptom scale.Study Design:Retrospective cross-sectional analysis.Setting:Tertiary, institutional.Patients:Nine hundred eighty-one adolescents (45% women) aged between 13 and 18 years.Independent Variables:Adolescents completed the SCAT5 symptom scale.Main Outcome Measures:The factor structure of SCAT5 examined using a principal axis factor analysis.Results:A 5-factor structure model explained 61% of the variance in symptoms. These 5 factors are identified as Energy (17%), Mental Health (13%), Migrainous (13%), Cognitive (9%), and Vestibulo-Ocular (9%). A similar 5-factor model emerged for each sex, and the proportion of variance in symptoms explained by the 5-factor model was comparable between the sexes.Conclusions:The findings of this report indicate that the SCAT5 symptoms aggregated into 5 delineated factors, and these factors were largely consistent across the sexes. The delineation of symptoms into 5 factors provides preliminary validation for the presence of different concussion phenotypes. Confirmatory factor analysis is warranted to examine the applicability and clinical utility of the use of the 5-factor structure in a clinical setting.

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“…Even in specialty concussion clinics, providers appear relatively reluctant to initiate headache specific treatment. We can see from Pearson et al [ 28 ] how providers are currently treating PTH in youth, with many physicians waiting to initiate therapy for 8 or even 12 weeks after injury. Popular treatments include vitamins/supplements, amitriptyline, and topiramate.…”

Section: Persistent Pth Treatment Modelsmentioning

confidence: 99%

Models for Treating Post-traumatic Headache

Kamins

2021

Curr Pain Headache Rep

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Purpose of Review To discuss the treatment of post-traumatic headache (PTH) and how to choose pharmacotherapy based upon known pathophysiology. Recent Findings Preclinical models of traumatic brain injury are finally revealing some of the mechanisms of PTH, including the significant role that inflammatory neuropeptides like calcitonin gene-related peptide (CGRP) play in the initiation and persistence of symptoms. Summary To effectively treat post-traumatic headache (PTH), one needs to understand the pathophysiology behind the initiation and persistence of symptoms. Recent animal models are starting to elucidate these mechanisms, but effective treatment will also likely rely on the identification of patients who are most at risk for persistent PTH. Trials of early, targeted therapy for at-risk patients will be needed to validate these hypotheses. Additionally, high powered clinical trials are lacking in the field of persistent PTH for medications that are known to be effective in primary headache disorders. Effective treatment for persistent PTH also requires understanding how headache interacts with the complex nature of persistent post-concussion symptoms, as this disease often necessitates a multi-disciplinary approach. Regardless, with the knowledge gained by new PTH models cited in this paper, and an increasing availability of novel headache medications, more effective treatment models are on the horizon.

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Survey of Child Neurologists on Management of Pediatric Post-traumatic Headache

Cited by 12 publications

References 40 publications

Evaluation of Posttraumatic Headache Phenotype and Recovery Time After Youth Concussion

Evaluation of Posttraumatic Headache Phenotype and Recovery Time After Youth Concussion

Factor Structure for the Sport Concussion Assessment Tool Symptom Scale in Adolescents After Concussion

Models for Treating Post-traumatic Headache

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