Elana Pinchefsky1, Alexander Sasha Dubrovsky2, Debbie Friedman3, Michael Shevell4. 1. Division of Pediatric Neurology, Departments of Pediatrics and Neurology/Neurosurgery, Montreal Children's Hospital / McGill University Health Centre (MUHC), Montreal, Quebec, Canada. 2. Department of Pediatric Emergency Medicine, Montreal Children's Hospital Trauma Centre, McGill University Health Centre, Montreal, Quebec, Canada. 3. Trauma Programs, Mild Traumatic Brain Injury Program, Concussion Clinic, Montreal, Quebec, Canada; Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. 4. Department of Pediatrics, Departments of Pediatrics and Neurology/Neurosurgery, Montreal Children's Hospital Trauma Centre, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: michael.shevell@muhc.mcgill.ca.
Abstract
BACKGROUND: Post-traumatic headache is one of the most common symptoms occurring after mild traumatic brain injury in children. METHODS: This is an expert opinion-based two-part review on pediatric post-traumatic headaches. In part II, we focus on the medical management of post-traumatic headaches. There are no randomized controlled trials evaluating the efficacy of therapies specifically for pediatric post-traumatic headaches. Thus, the algorithm we propose has been extrapolated from the primary headache literature and small noncontrolled trials of post-traumatic headache. RESULTS: Most post-traumatic headaches are migraine or tension type, and standard medications for these headache types are used. A multifaceted approach is needed to address all the possible causes of headache and any comorbid conditions that may delay recovery or alter treatment choices. For acute treatment, nonsteroidal anti-inflammatories can be used. If the headaches have migrainous features and nonsteroidal anti-inflammatories are not effective, triptans may be beneficial. Opioids are not indicated. Medication overuse should be avoided. For preventive treatments, some reports indicate that amitriptyline, gabapentin, or topiramate may be beneficial. Amitriptyline is a good choice because it can be used to treat both migraine and tension-type headaches. Nerve blocks, nutraceuticals (e.g. melatonin), and behavioral therapies may also be useful, and lifestyle factors, especially adequate sleep hygiene and strategies to cope with anxiety, should be emphasized. CONCLUSIONS: Improved treatment of acute post-traumatic headache may reduce the likelihood of developing chronic headaches, which can be especially problematic to effectively manage and can be functionally debilitating.
BACKGROUND: Post-traumatic headache is one of the most common symptoms occurring after mild traumatic brain injury in children. METHODS: This is an expert opinion-based two-part review on pediatric post-traumatic headaches. In part II, we focus on the medical management of post-traumatic headaches. There are no randomized controlled trials evaluating the efficacy of therapies specifically for pediatric post-traumatic headaches. Thus, the algorithm we propose has been extrapolated from the primary headache literature and small noncontrolled trials of post-traumatic headache. RESULTS: Most post-traumatic headaches are migraine or tension type, and standard medications for these headache types are used. A multifaceted approach is needed to address all the possible causes of headache and any comorbid conditions that may delay recovery or alter treatment choices. For acute treatment, nonsteroidal anti-inflammatories can be used. If the headaches have migrainous features and nonsteroidal anti-inflammatories are not effective, triptans may be beneficial. Opioids are not indicated. Medication overuse should be avoided. For preventive treatments, some reports indicate that amitriptyline, gabapentin, or topiramate may be beneficial. Amitriptyline is a good choice because it can be used to treat both migraine and tension-type headaches. Nerve blocks, nutraceuticals (e.g. melatonin), and behavioral therapies may also be useful, and lifestyle factors, especially adequate sleep hygiene and strategies to cope with anxiety, should be emphasized. CONCLUSIONS: Improved treatment of acute post-traumatic headache may reduce the likelihood of developing chronic headaches, which can be especially problematic to effectively manage and can be functionally debilitating.
Authors: Cydni N Williams; Mary E Hartman; Kristin P Guilliams; Rejean M Guerriero; Juan A Piantino; Christopher C Bosworth; Skyler S Leonard; Kathryn Bradbury; Amanda Wagner; Trevor A Hall Journal: Curr Treat Options Neurol Date: 2019-09-27 Impact factor: 3.598