Management of Post-Traumatic Headaches in Children and Adolescents / Multimodal Evaluation and Management of Children with Concussion: Using our heads and available evidence

Journal Reference: Kacperski, J and Todd Arthur. Management of Post-Traumatic Headaches in Children and Adolescents. Headache 2016;56:36-48.

Gioia, Gerard. Multimodal evaluation and management of children with concussion: Using our heads and available evidence. Brain Inj, 2015; 29(2): 195–206

Management of Post-Traumatic Headaches in Children and Adolescents DOI: 10.1111/ head.12737

Multimodal Evaluation and Management of Children with Concussion: Using our heads and available evidence DOI: 10.3109/02699052.2014.965210

Reviewer: Simon Cohen, Pain Specialist, Monash Children’s Hospital, Monash, VIC

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Review

One of the challenges and interest of a paediatric pain practice is the wide range of disciplines that we interact with and hence diagnoses. I would like to mention two papers stemming from a case from my own practice that required me to go back to the literature. This was a 15-year-old boy with a sports-related chronic post traumatic headache syndrome. Although not new, the two pragmatic review papers below stood out for different reasons.

The article by Kacperski has a good summary with a focus on pharmacological options to manage this issue of acute and persistent post traumatic headaches which allows consideration of a wide range of options to treat this difficult to manage condition.

The article by Gioia focuses on the multidisciplinary management of post concussive symptomatology. As the article states ‘It cannot be overstated that a comprehensive understanding of concussion diagnosis, injury manifestation and recovery course is multi-factorial. The data gathered from the concussion evaluation as a whole, must be understood within the context of the child’s pre-injury history, injury characteristics and presentation during assessment.’ Replace the word ‘concussion’ with ‘pain’ and it is obvious that there is a huge overlap with our management of the child with chronic pain, especially widespread pain with a fatigue component. This is a chance to learn how others manage a child with a chronic condition with a holistic rehabilitative approach. There is a section on pacing and counteracting nonproductive or incorrect thoughts/knowledge about mild traumatic brain injury which again, is echoed in good pain practice.