Headache Characteristic Changes During the Typical Recovery Period After Pediatric Sport-related Concussion
Brandon Wright1, Mark Roberts2, James Eckner3, Matthew Lorincz2, Andrea Almeida2, Michael Popovich2
1Kinesiology, 2Neurology, 3Physical Medicine and Rehabilitation, University of Michigan
Objective:
To describe headache characteristics following pediatric sport-related concussion (SRC).
Background:
SRC affects an estimated 3.8 million youth athletes in the United States annually. Headache is a common symptom following concussion and is closely tied to recovery, return-to-sport, return-to-learn and long-term morbidity. However, headache after concussion (HAC) has been poorly characterized after injury. Improved characterization of HAC may inform recovery progression and treatment to reduce the burden of concussion.
Design/Methods:
A retrospective case series was conducted in adolescent athletes who were assessed at an ambulatory sports concussion clinic. Inclusion criteria were met if the athlete was less than 18 years old, diagnosed with concussion, and seen in the clinic within 28 days from the date of injury (July 2018 to June 2019). Primary outcome measurements were headache consistency, frequency, duration, and association with migrainous symptoms during the immediate period (0 to 48 hours) and each of the four week-long periods following concussion. Generalized mixed linear models were constructed to compare headache characteristics at weekly intervals.
Results:
87 of 113 patient charts reviewed met the inclusion criteria for the study. The average age of patients was 14.9 years. 62% of the sample was male. All patients included experienced HAC. In the immediate post-injury period, headache was more commonly constant compared to episodic (p=0.002), and was more commonly associated with migrainous symptoms (p<0.001). By the third week post-injury, HAC became more commonly episodic compared to constant (p<0.001). 54% of the subjects experienced a transition from a constant migrainous headache to an episodic non-migrainous headache.
Conclusions:
During the initial post-injury periods, HAC was most commonly reported as constant and associated with migrainous symptoms. Over the 4-week period headaches became episodic and/or not associated with migrainous symptoms. These findings provide new characterization of HAC and may inform future HAC treatment studies and improve concussion recovery.