Article

Post-traumatic headaches (PTHs) following mild traumatic brain injury (mTBI)
are common; however, few studies have examined the characteristics of PTHs or
their response to treatment. The aims of this study were (1) to describe the
clinical characteristics of PTH in a prospective cohort of children presenting to
a paediatric emergency department with mTBI, and (2) to evaluate the response of
PTH to treatment. METHOD: The emergency department cohort was obtained from a
prospective longitudinal cohort study of symptoms following mTBI (n=670; 385
males, 285 females) and a comparison group of children with extracranial injury
(n=120; 61 males, 59 females). A retrospective chart review of a separate cohort
of children from a brain injury clinic (the treatment cohort) treated for PTH was
performed (n=44; 29 females, 15 males; mean age 14 y 1 mo, SD 3 y 1 mo). The
median time since injury was 6.9 months (range 1-29 mo). The mean follow-up
interval after treatment started was 5.5 weeks (SD 4.3 wks). RESULTS: Among the
emergency department cohort (n=39; 20 males, 19 females; mean age 11 y 1 mo, SD 4
y 3 mo) 11% of children were symptomatic with PTHs at a mean of 15.8 days (SD
11.6d) post injury. Three months post injury, 7.8% of children complained of
headaches; of those, 56% had pre-existing headaches and 18% had experienced
migraine before the injury. Although headache type varied, 55% met the criteria
for migraine. A family or past medical history of migraine was present in 82% of
cases. Among the treatment cohort, medications included amitriptyline,
flunarizine, topiramate, and melatonin, with an overall response rate of 64%.
CONCLUSION: This is the first prospective cohort study to describe the clinical
characteristics of PTHs following mTBI in children. Migraine was the most common
headache type seen; other headaches included tension-type, cervicogenic, and
occipital neuralgias, and 64% responded to treatment. Referral to a headache
specialist should be considered, especially when the features are not typical of
one of the primary headache disorders.
CI - (c) The Authors. Developmental Medicine & Child Neurology (c) 2013 Mac Keith
Press.

Langue : ANGLAIS