Adolescent girls with TBI may have an increased risk of headache one year after injury compared with controls, according to investigators.
SAVANNAH, GA—Children who experience traumatic brain injury (TBI) are at an increased risk for headache three months later—but for most children, this risk returns to normal one year after injury, researchers reported at the 40th Annual Meeting of the Child Neurology Society.
“The association between pediatric TBI and headache is significant overall and for girls and adolescents following mild TBI, as well as for younger children following moderate/severe TBI,” said Heidi K. Blume, MD, Assistant Professor of Neurology at Seattle Children’s Hospital and the University of Washington, Seattle.
TBI Versus Arm Injury
To determine whether pediatric TBI is associated with long-term headache, the investigators compared headache prevalence in children with TBI with that in children with an arm injury, who served as controls. They also examined age- and sex-related differences in headache frequency following mild and moderate/severe TBI. The study was open to all patients ages 5 to 17 who were treated for a TBI or an arm fracture in one of 10 study hospitals. At baseline, the researchers interviewed a parent/guardian of each child, and at three and 12 months, they conducted follow-up interviews with parents and adolescents ages 14 and older.
In the follow-up interviews, parents were asked to “rate any headache pain by indicating the child’s headache on average in the last week” on a scale of 0 to 10. Adolescents were asked to indicate how much they were bothered by headaches in the past week, as well as to rate their headache pain during the past week on a scale of 0 to 10 and on the Wong-Baker FACES scale.
The investigators defined “headache” as a pain score of 1 or more. They defined “serious headache” as a pain score of 5 or more on the parent surveys and as “bothered a lot,” a score of 5 or more, or report of C-F headache on the FACES scale in the adolescent surveys. The CDC Mild TBI Work Group report and patients’ Glasgow Coma Scale scores after injury were used to define mild, moderate, and severe TBI. Patients ages 5 to 12 were defined as children, and patients ages 13 to 17 were defined as adolescents.
A Three-Month Association
The study included 649 patients: 441 with mild TBI, 71 with moderate/severe TBI, and 137 with arm injury.
At three months, headache prevalence was significantly higher in patients with mild TBI than in controls among the overall cohort (43% vs 26.2%), adolescents (46.4% vs 25%), and girls (58.8% vs 23.8%). In addition, headache prevalence was higher in patients with moderate/severe TBI than in controls among younger children (60% vs 27%). For girls, serious headache was significantly more frequent after mild TBI than after arm injury, and for young children, serious headache was significantly more frequent after moderate/serious TBI than after arm injury. “The prevalence of headache increased with age in girls with mild TBI but not in boys or controls of either sex,” the researchers added.
In the three-month adolescent survey, 55% of girls with mild TBI versus 23% of control girls reported serious headache. In addition, 32% of girls with mild TBI versus 8% of control girls reported that they were “bothered a lot” by headache, and 64% of girls with mild TBI versus 11% of control girls indicated C-F on the FACES scale. However, there were no significant associations between mild TBI and headache for adolescent boys or between moderate/severe TBI and headache for adolescents of either sex.
At 12 months, headache prevalence was not significantly associated with mild TBI or moderate/severe TBI. However, serious headache was more common among girls with mild TBI than among control girls (27% vs 10%).
In the 12-month adolescent survey, girls with mild TBI reported more headaches than control girls on all questions, but the differences did not reach statistical significance. There were similar trends for girls with moderate/severe TBI.
“Adolescent girls with TBI may have an increased risk of headache one year after injury compared to controls,” the researchers concluded. “The epidemiology of headache following pediatric TBI appears to share some features with primary headache disorders such as migraine.
—Jack Baney