Post-traumatic headache is common after pediatric traumatic brain injury and affects thousands of children every year, but little is known about how headache affects recovery after traumatic brain injury in other symptom domains. We aimed to determine the association between headache and other common symptoms after pediatric traumatic brain injury and explore whether subjective complaints of headache are associated with objective deficits on specialized neurocognitive testing. We conducted a retrospective cohort study of children ages 3-19 years following traumatic brain injury with a completed Sports Concussion Assessment Tool (SCAT) questionnaire. Post-traumatic headache was defined by a score more than 2 on the SCAT question for headache and define headache groups for comparison. In our cohort, we analyzed data from the Delis-Kaplan Executive Function System and the Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II). Headache was reported in 40 (33%) patients presenting for post-traumatic brain injury care among 121 pediatric traumatic brain injury patients and did not differ by injury severity. Median total SCAT symptom score in the headache group was 5-fold higher compared to patients without headache (median 45.5 vs 9; P < .001). Significantly lower-scaled scores in color naming, matrix reasoning, letter sequencing, and letter switching were also found in the headache group (all P ≤ .03). Our study shows that headache, as reported by patients on the SCAT, is associated with higher symptom scores in all other symptom domains, including sleep, mood, sensory, and cognitive. Headache was also associated with worse objective neurocognitive measures and may identify patients who could benefit from specialized follow-up care and management.
FaulMXuLWaldMCoronadoVG. Traumatic brain injury in the United States: emergency department visits, hospitalizations and deaths 2002–2006. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. 2010.
2.
WilliamsCNPiantinoJMcEvoyCFinoNErikssonCO. The burden of pediatric neurocritical care in the United States. Pediatr Neurol. 2018;89:31–38.
3.
CoronadoVGHaileyesusTChengTA, et al.Trends in sports- and recreation-related traumatic brain injuries treated in US emergency departments: The National Electronic Injury Surveillance System–All Injury Program (NEISS-AIP) 2001-2012. J Head Trauma Rehabil. 2015;30(3):185–197.
4.
BabikianTMerkleyTSavageRCGizaCCLevinH. Chronic aspects of pediatric traumatic brain injury: review of the literature. J Neurotrauma. 2015;32(23):1849–1860.
5.
BlumeHKVavilalaMSJaffeKM, et al.Headache after pediatric traumatic brain injury: a cohort study. Pediatrics. 2012;129(1):e31–39.
6.
PowersSWPattonSRHommelKAHersheyAD. Quality of life in childhood migraines: clinical impact and comparison to other chronic illnesses. Pediatrics. 2003;112(1, pt 1):e1–e5.
7.
BabikianTAsarnowR. Neurocognitive outcomes and recovery after pediatric TBI: meta-analytic review of the literature. Neuropsychology. 2009;23(3):283–296.
PinchefskyEDubrovskyASFriedmanDShevellM. Part I—evaluation of pediatric post-traumatic headaches. Pediatr Neurol. 2015;52(3):263–269.
10.
PinchefskyEDubrovskyASFriedmanDShevellM. Part II—management of pediatric post-traumatic headaches. Pediatr Neurol. 2015;52(3):270–280.
11.
GeraGChesnuttJManciniMHorakFBKingLA. Inertial sensor-based assessment of central sensory integration for balance after mild traumatic brain injury. Mil Med. 2018;183(suppl 1):327–332.
12.
WilliamsCNKirbyAPiantinoJ. If you build it, they will come: initial experience with a multi-disciplinary pediatric neurocritical care follow-up clinic. Children (Basel, Switzerland). 2017;4(9).
13.
KuppermannNHolmesJFDayanPS, et al.Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet (London, England). 2009;374(9696):1160–1170.
14.
McCroryPJohnstonKMeeuwisseW, et al.Summary and agreement statement of the second international conference on concussion in sport, Prague 2004. Phys Sportsmed. 2005;33(4):29–44.
15.
SchneiderKJEmeryCAKangJSchneiderGMMeeuwisseWH. Examining Sport Concussion Assessment Tool ratings for male and female youth hockey players with and without a history of concussion. Br J Sports Med. 2010;44(15):1112–1117.
16.
ShehataNWileyJPRicheaSBensonBWDuitsLMeeuwisseWH. Sport concussion assessment tool: baseline values for varsity collision sport athletes. Br J Sports Med. 2009;43(10):730–734.
17.
CahillC. A compendium of neuropsychological tests (3rd edition). Acta Neuropsychiatrica. 2007;19(3):219–219.
18.
CanivezGLKonoldTRCollinsJMWilsonG. Construct validity of the Wechsler Abbreviated Scale of Intelligence and Wide Range Intelligence Test: convergent and structural validity. School Psychol Q. 2009;24(4):252.
19.
DelisDCKramerJHKaplanEHoldnackJ. Reliability and validity of the Delis-Kaplan Executive Function System: an update. J Int Neuropsychol Soc. 2004;10(2):301–303.
20.
HoffmanJMLucasSDikmenS, et al.Natural history of headache after traumatic brain injury. J Neurotrauma. 2011;28(9):1719–1725.
KirkCNagiubGAbu-ArafehI. Chronic post-traumatic headache after head injury in children and adolescents. Dev Med Child Neurol. 2008;50(6):422–425.
23.
WalkerWCSeelRTCurtissGWardenDL. Headache after moderate and severe traumatic brain injury: a longitudinal analysis. Arch Phys Med Rehabil. 2005;86(9):1793–1800.
24.
BernardCOPonsfordJAMcKinlayAMcKenzieDKrieserD. Predictors of post-concussive symptoms in young children: injury versus non-injury related factors. J Int Neuropsychol Soc. 2016;22(8):793–803.
25.
BerzKDivineJFossKBHeylRFordKRMyerGD. Sex-specific differences in the severity of symptoms and recovery rate following sports-related concussion in young athletes. Phys Sportsmed. 2013;41(2):58–63.
26.
EisenbergMAAndreaJMeehanWMannixR. Time interval between concussions and symptom duration. Pediatrics. 2013;132(1):8–17.
27.
IversonGLGardnerAJTerryDP, et al.Predictors of clinical recovery from concussion: a systematic review. Br J Sports Med. 2017;51(12):941–948.
28.
KuczynskiACrawfordSBodellLDeweyDBarlowKM. Characteristics of post-traumatic headaches in children following mild traumatic brain injury and their response to treatment: a prospective cohort. Dev Med Child Neurol. 2013;55(7):636–641.
29.
OlssonKALloydOTLebrocqueRMMcKinlayLAndersonVAKenardyJA. Predictors of child post-concussion symptoms at 6 and 18 months following mild traumatic brain injury. Brain Inj. 2013;27(2):145–157.
30.
TkachenkoNSinghKHasanajLSerranoLKothareSV. Sleep disorders associated with mild traumatic brain injury using sport concussion assessment tool 3. Pediatr Neurol. 2016;57:46–50.e41.
31.
Begasse de DhaemOBarrWBBalcerLJGalettaSLMinenMT. Post-traumatic headache: the use of the Sport Concussion Assessment Tool (SCAT-3) as a predictor of post-concussion recovery. J Headache Pain. 2017;18(1):60.
32.
BruniORussoPMFerriRNovelliLGalliFGuidettiV. Relationships between headache and sleep in a non-clinical population of children and adolescents. Sleep Med. 2008;9(5):542–548.
33.
DosiCFiguraMFerriRBruniO. Sleep and headache. Seminars in Pediatr Neurol. 2015;22(2):105–112.
34.
HollandPR. Headache and sleep: shared pathophysiological mechanisms. Cephalalgia. 2014;34(10):725–744.
35.
KutukMOTufanAEGulerG, et al.Migraine and associated comorbidities are three times more frequent in children with ADHD and their mothers. Brain Dev. 2018;40:857–864.
36.
Torres-FerrusMVila-SalaCQuintanaM, et al.Headache, comorbidities and lifestyle in an adolescent population (The TEENs Study). Cephalalgia. 2019;39(1):91–99.
37.
AndersonVCatroppaCMorseSHaritouFRosenfeldJ. Functional plasticity or vulnerability after early brain injury?Pediatrics. 2005;116(6):1374–1382.
38.
AndersonVAMorseSACatroppaCHaritouFRosenfeldJV. Thirty month outcome from early childhood head injury: a prospective analysis of neurobehavioural recovery. Brain. 2004;127(pt 12):2608–2620.
39.
Ewing-CobbsLBarnesMFletcherJMLevinHSSwankPRSongJ. Modeling of longitudinal academic achievement scores after pediatric traumatic brain injury. Dev Neuropsychol. 2004;25(1-2):107–133.
40.
SchacharRLevinHSMaxJEPurvisKChenS. Attention deficit hyperactivity disorder symptoms and response inhibition after closed head injury in children: do preinjury behavior and injury severity predict outcome?Dev Neuropsychol. 2004;25(1-2):179–198.
41.
TaylorHGYeatesKOWadeSLDrotarDStancinTMinichN. A prospective study of short- and long-term outcomes after traumatic brain injury in children: behavior and achievement. Neuropsychology. 2002;16(1):15–27.
42.
KarrJEAreshenkoffCNGarcia-BarreraMA. The neuropsychological outcomes of concussion: a systematic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury. Neuropsychology. 2014;28(3):321–336.
43.
KonigsMEngenhorstPJOosterlaanJ. Intelligence after traumatic brain injury: meta-analysis of outcomes and prognosis. Eur J Neurol. 2016;23(1):21–29.
44.
KanazawaS. Mind the gap…in intelligence: re-examining the relationship between inequality and health. Br J Health Psychol. 2006;11(pt 4):623–642.
45.
McNallyKABangertBDietrichA, et al.Injury versus noninjury factors as predictors of postconcussive symptoms following mild traumatic brain injury in children. Neuropsychology. 2013;27(1):1–12.
46.
BrooksBLKadouraBTurleyBCrawfordSMikrogianakisABarlowKM. Perception of recovery after pediatric mild traumatic brain injury is influenced by the “good old days” bias: tangible implications for clinical practice and outcomes research. Arch Clin Neuropsychol. 2014;29(2):186–193.
47.
de AraújoCMBarbosaIGLemosSMADominguesRBTeixeiraAL. Cognitive impairment in migraine: a systematic review. Dement Neuropsychol. 2012;6(2):74–79.
SmithAP. Acute tension-type headaches are associated with impaired cognitive function and more negative mood. Front Neurol. 2016;7:42.
50.
SilverbergNDIversonGLPanenkaW. Cogniphobia in mild traumatic brain injury. J Neurotrauma. 2017;34(13):2141–2146.
51.
DoddJHallTGuilliamsK, et al.Optimizing neurocritical care through the integration of neuropyschology. Pediatric Neurol. 2018;89:58–62.
52.
The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629–808.
53.
BablFEDionisioDDavenportL, et al.Accuracy of components of SCAT to identify children with concussion. Pediatrics. 2017;140(2).
54.
McCroryPMeeuwisseWAubryM, et al.Consensus statement on concussion in sport—The 4th International Conference on Concussion in Sport held in Zurich, November 2012. Phys Ther Sport. 2013;14(2):e1–e13.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
