title: Characteristics of post-traumatic headaches in children following mild traumatic brain injury and their response to treatment: a prospective cohort.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Calgary, Calgary, AB, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Kuczynski
authors.forename: Susan
authors.initials: S
authors.lastname: Crawford
authors.forename: Lisa
authors.initials: L
authors.lastname: Bodell
authors.forename: Deborah
authors.initials: D
authors.lastname: Dewey
authors.forename: Karen M
authors.initials: KM
authors.lastname: Barlow
mesh_terms: D000293:Adolescent; D000639:Amitriptyline / Q000008:administration & dosage; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D001930:Brain Injuries / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D002492:Central Nervous System Depressants / Q000008:administration & dosage; D002648:Child; D015331:Cohort Studies; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage; D008297:Male; D008550:Melatonin / Q000008:administration & dosage; D051298:Post-Traumatic Headache / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D011446:Prospective Studies
chemical_list: D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D002492:Central Nervous System Depressants; D000639:Amitriptyline; D008550:Melatonin; D007213:Indomethacin