Pediatric Mild TBI May Up Risk for Posttraumatic Headache Months After Injury

The risk for posttraumatic headache increases in children following a mild traumatic brain injury (TBI), compared with children with a mild orthopedic injury for up to 3 months postinjury. However, there are no differences reported 6 months postinjury between the 2 groups. These are the findings of a prospective, longitudinal study published in the journal Cephalalgia.

Although posttraumatic headache is often reported in children following mild TBI, the rates, trajectories, risk factors, and clinical presentation in this patient population remain to be elucidated. Children who experience mild TBI frequently exhibit somatic, affective, and cognitive symptoms, which usually resolve within 1-month following an injury; however, in 15% to 25% of these patients, their symptoms persist. 

For the study, researchers sought to explore the rate, trajectory, risk factors, and features of posttraumatic headache following mild TBI and examine posttraumatic headache classification following mild TBI.

For the purposes of comparison, they included children who experience an orthopedic injury, based on the similarity of these individuals to those who experience mild TBI in terms of key pre- and postinjury issues. It was anticipated that the rates of posttraumatic headache at early (ie, approximately 10 days) and chronic postinjury times would be greater following mild TBI than following orthopedic injury — particularly among older children, females, and those who experienced premorbid headache.

Participants in the mild TBI group included children who had sustained a head trauma that was associated with ≥1 of the following criteria, which were consistent with those of the World Health Organization:

• Observed loss of consciousness for <30 minutes
• Glasgow Coma Scale score of 13 or 14
• ≥2 Acute signs or symptoms of concussion

Children included in the orthopedic injury group comprised those who had sustained an upper or lower extremity extracranial fracture that was associated with an Abbreviated Injury Scale score of <4.

The study sample included a total of 213 individuals between ages 8.00 and 16.99 who were recruited from 1 of 2 pediatric emergency departments (EDs) within <24 hours of experiencing a mild TBI (n=139) or a mild orthopedic injury (n=74). All parents completed a standardized questionnaire at 10 days, 3 months, and 6 months postinjury. The questionnaire was used to categorize the premorbid and posttraumatic headache as a migraine, a tension-type headache, or a headache that was not otherwise classified.

The researchers found that the risk for posttraumatic headache was greater following mild TBI than following mild orthopedic injury at 10 days postinjury (odds ratio [OR], 197.41; 95% CI, 45.64-853.78; P <.001) and at 3 months postinjury (OR, 3.50; 95% CI, 1.13-10.85; P =.030), which was particularly common among children without premorbid headache. Further, posttraumatic headache occurred more often following a mild TBI than following a mild orthopedic injury (β= 0.80; 95% CI, 0.05-1.55; P =.038).

Several limitations of the current analysis warrant mention. The lack of a group difference in the prevalence of posttraumatic headache at 6 months postinjury reported in the multivariate models might have been reflective of reduced statistical power at this timepoint. Further, participants who are recruited from pediatric EDs may not be representative of children in other types of clinical settings or of those who do not seek care.

“No distinct phenotype was found to be clearly associated with PTH [posttraumatic headache] after [mild] TBI,” the researchers noted. “Future investigations into the relationship between PTH and other outcomes of pediatric [mild] TBI could improve prognostication and help guide clinical management,” they concluded.