Objective:

We aimed to evaluate headache burden in children with acquired brain injury (ABI) after pediatric intensive care unit (PICU) admission and evaluate associations between sleep and quality of life (QOL) outcomes.  We hypothesized that headaches would be common and associated with worse outcomes.

Background:

Neurologic diagnoses account for 20% of PICU admissions. While headache is a frequently reported complication of trauma diagnoses, less is known about the frequency and impact of headaches in children following PICU admission with ABI (including non-traumatic causes), or the relationship to other important outcomes.

Design/Methods:

We performed a retrospective cohort study in 184 ABI patients >6 years of age (M age= 13.1 years; 40% female) completing follow-up in a post-PICU clinic. Headaches were evaluated by self-report pain questionnaire 1-3 months after hospital discharge. We measured sleep outcomes with the Sleep Disturbance Scale for Children, and QOL was measured with the Pediatric Quality of Life Inventory Core Scale (PedsQL). The relationship between headaches and clinical and demographic factors was evaluated using Chi-square tests and Spearman correlation (rs). Significance defined as p<.05.

Results:

Weekly or more frequent headaches post-discharge were reported in 98 (53%) youth, more often among females (66% vs 44% males, p=.04). Headaches were common in children with all primary diagnoses: hypoxic ischemic injury (50%), infectious and inflammatory (52%), stroke (90%), trauma (52%). Thirty percent overall reported average pain intensity >3/10 and 13% reported >3 headaches/week. Among 98 children with headaches, worse sleep correlated with increased headache frequency (rs=.27, p=.01) and pain intensity (rs=.36, p<.001); similarly, lower QOL correlated with increased headache frequency (rs=-.23, p=.02) and pain intensity (rs=-.28, p=.01).  

Conclusions:

Patients with ABI frequently report post-discharge headaches regardless of primary diagnosis. Severity and frequency of headaches are correlated with worse sleep and quality of life. Headaches may represent an important modifiable factor for improving recovery.