Chapter 16: Posttraumatic Headache

INTRODUCTION

Traumatic brain injury (TBI) is one of the most common injuries in the pediatric age group. It is estimated that as many as half a million children younger than 15 years sustain TBIs that require hospital-based care in the United States each year, with the majority of these injuries being mild in severity.¹ A national cross-sectional study in the United States estimated that 1 of every 220 pediatric patients seen in emergency departments (EDs) receives a diagnosis of mild TBI (mTBI).² Headaches are the most common symptom after an mTBI and often occur with a constellation of physical, cognitive, emotional, and behavioral signs and symptoms.³

POSTTRAUMATIC HEADACHES

Headache after an mTBI, referred to as posttraumatic headache (PTH), is one of the most common and disabling symptoms after a head injury. Headache has been reported in as many as 86% of high school and college athletes who have suffered from head trauma.⁴ Eisenberg et al⁵ reported that 85% of pediatric patients presented to a pediatric ED with headache following an mTBI.⁵ Kuczynski et al⁶ reported that 11% of pediatric patients who presented to a university hospital ED with mTBI continued to report headache 2 weeks after injury. Headaches may affect a child’s ability to function and participate in school and extracurricular activities, which can cause disability and impair their quality of life.³

Definition

The International Classification of Headache Disorders, Third Edition (ICHD-3) classifies PTHs as a secondary headache type defined as acute if lasting less than 3 months and persistent if lasting more than 3 months after injury. The classification for acute and persistent PTH (PPTH) is summarized in Tables 16–1 and 16–2. Although the ICHD-3 criteria state that PTHs begin within 7 days after injury to the head or after regaining consciousness, this 7-day cutoff is arbitrary, and some experts believe that headaches may develop after a longer interval.⁷