title: Does analgesic overuse contribute to chronic post-traumatic headaches in adolescent concussion patients?
abstract: BACKGROUND
  The causes of persistent headache following concussion are poorly understood. The objective of this study is to explore analgesic overuse as a potential cause of chronic post-traumatic headache among adolescents referred to a headache clinic following concussion.
  
  
  METHODS
  A retrospective chart review was conducted of all adolescent concussion patients referred to our pediatric headache clinic over the 16-month period between August 1, 2011, and November 30, 2012. Those patients with chronic post-traumatic headaches of 3-12 months' duration who also met International Headache Society criteria for probable medication-overuse headache were identified. Demographic data, concussion symptoms, and headache features were characterized from the initial evaluation and from follow-up visits.
  
  
  RESULTS
  Of 104 adolescent concussion patients referred during the study period, 77 had chronic post-traumatic headache of 3-12 months' duration. Fifty-four of 77 (70.1%) met criteria for probable medication-overuse headache. Only simple analgesics were overused. Thirty-seven patients (68.5%) had resolution of headaches or improvements to preconcussion headache patterns after discontinuing analgesics; seven (13%) had no change in headaches or worsening of headaches after discontinuing analgesics and 10 (18.5%) did not discontinue analgesics or were lost to follow-up.
  
  
  CONCLUSIONS
  Excessive use of analgesics postconcussion may contribute to chronic post-traumatic headaches in some adolescents. Management of patients with chronic post-traumatic headache should include analgesic detoxification when medication overuse is suspected.
authors.affiliation: Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio; Department of Neurology, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio. Electronic address: geoffrey.heyer@nationwidechildrens.org.
authors.forename: Geoffrey L
authors.initials: GL
authors.lastname: Heyer
authors.affiliation: Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio; Department of Neurology, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio.
authors.forename: Syed A
authors.initials: SA
authors.lastname: Idris
mesh_terms: D000293:Adolescent; D000700:Analgesics / Q000009:adverse effects* / Q000627:therapeutic use; D001924:Brain Concussion / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D051298:Post-Traumatic Headache / Q000139:chemically induced* / Q000188:drug therapy; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000700:Analgesics
keywords: TBI; adolescent; concussion; medication-overuse headache; pediatric; post-traumatic headache