Research In Action

Post-traumatic headache (PTH) is the most common symptom after a young person sustains a concussion. Previous research has shown that 8% of youth experience PTH more than three months after their injury. Despite the common occurrence of PTH, there are no established treatment guidelines related to pharmacologic and non-pharmacologic interventions and therapies for those presenting with headache symptoms. 

A panel of post-traumatic headache specialists in collaboration with the American Headache Society and pediatric special interest groups has published a white paper on headache management in concussed youth. As the paper’s lead author, I am excited to share our findings and recommendations that help to better identify risk factors for prolonged recovery and provide guidance for addressing PTH. 

Why These Guidelines Are Needed

The Minds Matter Concussion Program at Children’s Hospital of Philadelphia has been a leader in conducting translational research that has demonstrated the importance of a returning to activities of daily living shortly after a concussion occurs. This includes returning to school and low impact cardiovascular activity that is guided by symptoms and avoids re-injury—an approach which substantially improves recovery.

Despite these important advances, no guidelines and limited evidence exist on headache-directed care in youth with concussion. This is important because headache is not only the most common symptom to present in concussed youth, but also the most common symptom to persist for longer than one month. Migraine-like headache can occur after concussion, which is marked by moderate-to-severe head pain that comes with other symptoms, such as light sensitivity, sound sensitivity, and/or nausea, and can impact daily function. This can serve as a barrier to returning to activities of daily living, which we know is important in concussion recovery. 

Because of this, there may be a role for thoughtful use of as-needed over-the-counter medications like non-steroidal anti-inflammatory medications. It’s important to note that overuse of these medicines can worsen headaches in the long term. Other treatments used in migraine, including vitamins like magnesium and riboflavin, may offer a low side effect option for reducing headache symptoms over time. Finally, for migraine-like headaches that do not respond to these initial therapies, other preventive prescription medications should be considered after weighing the risks and benefits. 

Directions For Future Research

Gaps in knowledge on how to best treat post-traumatic headache exist. Current recommendations are based on a combination of small retrospective studies and expert opinion. Randomized control trials – the gold standard for determining what treatments work best – are lacking. This is an important direction for future research to determine the treatments that will be most effective for managing post-traumatic headache in youth.