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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

Table 16–1.International Classification of Headache Disorders, Third Edition (ICHD-3) definition of acute headache attributed to traumatic injury to the head.

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