The use of ibuprofen and acetaminophen for acute headache in the postconcussive youth: A pilot study

Abstract

Objective: Acute postconcussive headaches are problematic for children after mild traumatic brain injury. There are no evidence-based guidelines for their management. This pilot study aims to assess the feasibility and efficacy of routine analgesia administration. Methods: A four-arm open-label randomized controlled trial pilot/feasibility study was conducted: (i) acetaminophen, (ii) ibuprofen, (iii) alternating acetaminophen and ibuprofen and (iv) a control group. Children and youth 8 to 18 years of age presenting to emergency department with headache within 48 hours of their first concussion were recruited consecutively and sequentially randomized. Children with abnormal neuroimaging, history of previous concussions and bleeding disorder were excluded. A headache survey was administered at recruitment. All participants were provided with standard concussion management education and were also instructed on how to use the headache diary for the 1-week study follow-up period. The diary captures (i) headache days, (ii) number of headaches, (iii) headache intensity and (iv) return-to-school information. Feasibility was assessed based on study recruitment and compliance. Results: There were no feasibility concerns with the recruitment and no major compliance issues. Patients on acetaminophen, ibuprofen or both had significantly less headache days, episodes of headache and lower headache intensity than did the standard care group. Patients on both ibuprofen and acetaminophen (79.0%) and on ibuprofen alone (61.0%) were more likely to be back at school 1 week postinjury as compared with the acetaminophen group (33.3%) and the standard care group (21.1%). Conclusion: Results showed routine analgesia administration was feasible and effective for postconcussive headache management. A larger full-scale randomized controlled trial is required to further assess the efficacy with longer follow-up, a wider variety of patients and more concussion related outcomes. L'utilisation d'ibuprofène et d'acétaminophène pour soulager les céphalées aiguës postcommotionnelles : une étude piloteObjectif : Les céphalées postcommotionnelles posent problème chez les enfants après une légère commotion cérébrale. Il n'y a pas de lignes directrices factuelles sur leur prise en charge. La présente étude pilote vise à évaluer la faisabilité et l'efficacité de l'administration systématique d'analgésiques. Méthodologie : Les chercheurs ont réalisé une étude pilote et de faisabilité ouverte, aléatoire et contrôlée en quatre volets : i) acétaminophène, ii) ibuprofène, iii) alternance entre l'acétaminophène et l'ibuprofène et iv) groupe témoin. Des enfants et des adolescents de huit à 18 ans qui ont consulté à l'urgence à cause de céphalées dans les 48 heures suivant une première commotion ont été recrutés de manière consécutive, séquentielle et aléatoire. Les enfants dont la neuro-imagerie était anormale ou qui avaient des antécédents de commotion ou des troubles hémostatiques étaient exclus. Les enfants ont répondu

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

“…The best evidence comes from a prospective randomized open‐label study assessing scheduled acetaminophen, ibuprofen, or both compared to standard of care started within the first week of mTBI to treat PTH. Alternating ibuprofen and acetaminophen resulted in the fewest number of headache days and highest return‐to‐school rate, followed by ibuprofen alone, then acetaminophen alone 17 . Only median and range values were reported; no formal statistical significance testing was done.…”

“…In summary, oral and IV abortive therapies administered within the first days following mTBI may offer immediate relief for PTH. Fair evidence supports alternating ibuprofen and acetaminophen in the first week, 17 as well as greater efficacy of HTS than NS in alleviating acute PTH 23 . Two studies provided poor evidence for acute benefit of IV medications commonly used to treat migraine 25,26 .…”

“…Treatments that have been studied include abortive and preventative medications, procedures, neuromodulation, PT, exercise, collaborative care models, and behavioral therapies. There were two RCTs that supported the use of acetaminophen and ibuprofen 17 and IV HTS 23 in acute PTH. Overall evidence for preventative therapies was significantly limited by small sample sizes and lack of comparator groups.…”

“…Alternating ibuprofen and acetaminophen resulted in the fewest number of headache days and highest return-to-school rate, followed by ibuprofen alone, then acetaminophen alone. 17 Only median and range values were reported; no formal statistical significance testing was done.…”

Rehabilitation of Concussion and Persistent Postconcussive Symptoms

“…83 Treatment for postconcussion headaches includes cervical physical therapy, vestibulo-ocular rehabilitation, aerobic exercise, sleep restoration, cognitive therapy modalities, and over-the-counter medications. There is some evidence of benefit in the acute postconcussion phase in patients who used acetaminophen or ibuprofen for 72 hours after injury, 84 but clinicians should be aware of the risk of medication overuse headaches. 83 Postconcussion migraine headaches, which often represent an exacerbation of a prior migraine condition, should be treated with standard migraine pharmacotherapy and other modalities (e.g., Botox injections).…”