Each year, over half a million children, through age 14, are seen in the emergency room to be evaluated for traumatic brain injury (TBI). Although most recover within a few days after sustaining a concussion or mild traumatic brain injury (mTBI), there are some children who continue to be symptomatic for months afterward. Studies have shown up to 14% of school age children have lingering symptoms such as difficulty concentrating, blurry vision, irritability and sleeping more than normal three months after an mTBI, and another 2.3 % continue to have symptoms 12 months after their mTBI. Headache is depicted as the one of the most common consequences of TBI in adults, but there is little data on headache in children after TBI. Dr. Heidi Blume of Seattle Children's Hospital, conducted a recent study, Headache After Pediatric Traumatic Brain Injury: A Cohort Study, to determine what the frequency of headache was in children, ages 5 to 17, after suffering a TBI.
The participants, all children under 18 years of age, were divided into two groups who were treated in emergency room departments. The control group was treated for a broken limb while the other group was treated for TBI. A fall or getting hit on the head with an object were the most common form of injury to be treated. The more serious TBI's were from a motor vehicle or bike accident or a fall. To define the TBI group, it was broken down into two separate groups; children who suffered mild traumatic brain injury (mTBI) and those who endured moderate/severe traumatic brain injury (TBI.) The groups were then followed up at three and 12 months after the initial injury and came from 10 different medical facilities in King County, Washington, and Philadelphia, Pennsylvania. All research participants were treated between Marc,h 2007, and September, 2008.
To define headache in this study, the information came from a questionnaire that was filled out by either a parent or guardian as soon as possible after the initial injury and again at three and 12 months. The questionnaire was the same at each interval.
- Parents/guardians were asked to "rate any headache pain by indicating the child's headache on the average in the last week." They used a 0 - 10 scale where "0 is no pain and 10 is pain as bad as you can imagine.
Children over the age of 14 answered three questions in regards to headache at three and 12 months:
- "In the past 4 weeks, how much have you been bothered by headaches?" Their choices were; "not bothered," "bothered a little," and "bothered a lot."
- "Please rate any headache pain by indicating the number that best describes your headache on average in the past week." A scale of 0 to 10 was used.
- "Which face shows how much your head hurt in the past week?" The Wong-Baker FACES pain scale was used. This is an easy pain scale with pictures of faces for children to use. The faces range from happy in no pain (0 =no hurt,) to sad and crying in lots of pain (5= Hurts as much as you can imagine.)
The groups' demographics were divided by age (over or under 12 years,) the race of each patient, their gender, whether or not the child had insurance and the education level of the parent or guardian. Because headache is one of the most frequently reported symptoms in adults after a TBI, the researchers set out to investigate if there was any difference in the severity and frequency of headache in gender and age (5 -7, 8-10, 11-13, and 14-17 years old) at three months and 12 months. Over 1627 patients with TBI and 1905 with a broken limb were suitable for the study, but only 512 children with TBI and 136 children with a broken limb actually participated in the study. At three months the researchers found:
- Parents/guardians stated that 43% of children had headache after mTBI; 37% with moderate to severe TBI and 26% of controls (children who broke a limb)
- Girls at three months after mTBI had a much higher risk of getting any type of headache compared to boys - 59% vs. 24%.
- Children ages 5 - 12 with TBI frequently had more headaches than the control group; 60% vs. 27%.
- Serious headache frequency increased in mTBI for most and in teens, but was much higher in girls 29% vs. 10%.
- As girls aged so did their headache frequency and severity; 7%-five to seven year olds, 20%-girls aged 8 - 10, 29%-girls 11 - 13 and 45%-girls, 14 -17 had an increase in severity and frequency of their headaches three months after a mTBI. This did not happen in the boy population.
When followed up at 12 months, parents/guardians of the participants reported:
- 41% of children who suffered an mTBI experienced headache as did 34% with moderate/severe TBI.
- Again, girls had a greater frequency of headache than boys, 52% vs. 36%.
- Younger children did not seem to have an increased frequency of headache compared with controls at 12 months.
- Girls with mTBI had a higher ratio of serious headache compared to the control group, 27% vs. 10 %.
In conclusion, younger children and girls suffer headache for a significant time period after a TBI. According to researchers, "there may also be an association between both mild and moderate/severe TBI and headache 1 year after injury for adolescent girls." For this reason, researchers feel the epidemiology of headache after TBI could possibly have the same epidemiology of Migraine and other primary headache disorders. The study indicates the time it takes to recover from a TBI may be different for boys and girls. Compared with adults, children and girls recovery is not the same.
Blume, Heidi, M.D.; Vavilala, Monica, S. M.D.; Jaffe, Kenneth, M. M.D.; Koepsell, Jin, M.D.; Temkin, Nancy, M.D.; Durbin, Dennis, M.D.; Dorsch, Andrea, M.D.; Riverara, Frederick, P., M.D. "Headache After Pediatric Traumatic Brain Injury: A Cohort Study." Pediatrics. DDOI: 10.1542/peds.2011-1742 Pediatrics; originally published online December 5, 2011.
"Injury Prevention & Control: Traumatic Brain Injury. How Many People Have Traumatic Brain Injury?" Center for Disease Control and Prevention. http://www.cdc.gov/traumaticbraininjury/statistics.html#A. Last updated December 2, 2011.
"Injury Prevention & Control: Traumatic Brain Injury." Concussion. Center for Disease Control and Prevention.
http://www.cdc.gov/concussion/signs_symptoms.html. Last updated March 8, 2010.
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Last updated January 11, 2012.
Published On: January 11, 2012