Child Neurology Society survey of practitioners on management of pediatric post-traumatic headache

Abstract

Background Traumatic brain injury (TBI) is a significant cause of morbidity in the pediatric population with headache being the most common postconcussive symptom. There are no established guidelines for the management of pediatric post-traumatic headache (PTH). This study aimed to better characterize common clinical practices of child neurologists in order to guide additional research in this area. Methods Members of the Child Neurology Society were surveyed. Results Ninety five practitioners responded to the survey. Respondents were heterogeneous in their experience and practice setting 33.7% of respondents evaluated less than 25 pediatric concussion patients per year, 40.0% evaluated 25-50, and 26.3% saw >50 per year. The majority saw patients with subacute to persistent, mild TBI. 38.9% of practitioners reported that they consistently use the International Classification of Headache Disorders (ICHD) criteria to diagnose pediatric PTH, however only 18.9% correctly defined PTH as persistent at 12 weeks, as per ICHD classification. A majority of respondents recommended NSAIDs as abortive therapy after PTH, but instructions regarding timing after injury and frequency of use varied. The time-after-injury when prophylactic headache medication was recommended also varied one-third considered prophylaxis within 1 month and one-third between 1 and 2 months. The medications most commonly used for prophylaxis were amitriptyline (93.7%), topiramate (71.6%), and vitamins/supplements (58.9%). Injection-based therapies were used by 38.0%. 93.7% recommended non-medical treatments, and 38.0% recommended injection-based therapies. Prescriptions for cognitive and physical rest and return to play were also variable one-third of respondents recommended cognitive and physical rest for 1-3 days followed by progressive return to cognitive and physical activities, which is consistent with current guidelines. Conclusions As there are no established guidelines on management of PTH, it is not surprising that diagnosis and management varies considerably. Further studies are needed to define the best, evidence-based practices for pediatric PTH.