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Postconcussion migraines

Meeryo Choe, Karen M Barlow
PURPOSE OF REVIEW: This article summarizes the impact and complications of mild traumatic brain injury and concussion in children and outlines the recent evidence for its assessment and early management. Useful evidence-based management strategies are provided for children who have a typical recovery following concussion as well as for those who have persistent postconcussion syndrome. Cases are used to demonstrate the commonly encountered pathologies of headache, cognitive issues, and mood disturbances following injury...
February 2018: Continuum: Lifelong Learning in Neurology
Lauren Shaw, Maria Morozova, Ishaq Abu-Arafeh
The aim of this systematic review is to determine the prevalence and clinical features of chronic post-traumatic headache (CPTH) in children and adolescents. Literature search of PubMed, Embase, Cochrane databases and Google Scholar was carried out for all studies reporting on CPTH in children and young people under the age of 18 years between January 1980 and November 2016. Search command included post-traumatic headache, postconcussion syndrome, child and adolescent. Demographic data, diagnostic criteria of headache disorders, occurrence of headache after head injury and headache phenotypes were collected...
January 2018: Pain Management
John Leddy, John G Baker, Mohammad Nadir Haider, Andrea Hinds, Barry Willer
Management of the athlete with postconcussion syndrome (PCS) is challenging because of the nonspecificity of PCS symptoms. Ongoing symptoms reflect prolonged concussion pathophysiology or conditions such as migraine headaches, depression or anxiety, chronic pain, cervical injury, visual dysfunction, vestibular dysfunction, or some combination of these. In this paper, we focus on the physiological signs of concussion to help narrow the differential diagnosis of PCS in athletes. The physiological effects of exercise on concussion are especially important for athletes...
March 2017: Journal of Athletic Training
L M Alhilali, J Delic, S Fakhran
BACKGROUND AND PURPOSE: Posttraumatic migraines are common after mild traumatic brain injury. The purpose of this study was to determine if a specific axonal injury pattern underlies posttraumatic migraines after mild traumatic brain injury utilizing Tract-Based Spatial Statistics analysis of diffusion tensor imaging. MATERIALS AND METHODS: DTI was performed in 58 patients with mild traumatic brain injury with posttraumatic migraines. Controls consisted of 17 patients with mild traumatic brain injury without posttraumatic migraines...
April 2017: AJNR. American Journal of Neuroradiology
Zuzana Novak, Mary Aglipay, Nick Barrowman, Keith O Yeates, Miriam H Beauchamp, Jocelyn Gravel, Stephen B Freedman, Isabelle Gagnon, Gerard Gioia, Kathy Boutis, Emma Burns, Andrée-Anne Ledoux, Martin H Osmond, Roger L Zemek
Importance: Persistent postconcussion symptoms (PPCS) pose long-term challenges and can negatively affect patients' health-related quality of life (HRQoL). To date, no large comprehensive study has addressed the association between PPCS and HRQoL. Objectives: To determine the association between HRQoL and PPCS at 4 weeks after concussion and assess the degree of impairment of HRQoL in the subsequent 12 weeks. Design, Setting, and Participants: In a prospective, multicenter cohort study (Predicting Persistent Postconcussive Problems in Pediatrics [5P]) from August 14, 2013, to September 30, 2014, children aged 5 to 18 years who presented to the emergency department within 48 hours after head injury and were considered to have an acute concussion were enrolled across 9 pediatric emergency departments within the Pediatric Emergency Research Canada Network...
December 5, 2016: JAMA Pediatrics
Roger Zemek, Nick Barrowman, Stephen B Freedman, Jocelyn Gravel, Isabelle Gagnon, Candice McGahern, Mary Aglipay, Gurinder Sangha, Kathy Boutis, Darcy Beer, William Craig, Emma Burns, Ken J Farion, Angelo Mikrogianakis, Karen Barlow, Alexander S Dubrovsky, Willem Meeuwisse, Gerard Gioia, William P Meehan, Miriam H Beauchamp, Yael Kamil, Anne M Grool, Blaine Hoshizaki, Peter Anderson, Brian L Brooks, Keith Owen Yeates, Michael Vassilyadi, Terry Klassen, Michelle Keightley, Lawrence Richer, Carol DeMatteo, Martin H Osmond
IMPORTANCE: Approximately one-third of children experiencing acute concussion experience ongoing somatic, cognitive, and psychological or behavioral symptoms, referred to as persistent postconcussion symptoms (PPCS). However, validated and pragmatic tools enabling clinicians to identify patients at risk for PPCS do not exist. OBJECTIVE: To derive and validate a clinical risk score for PPCS among children presenting to the emergency department. DESIGN, SETTING, AND PARTICIPANTS: Prospective, multicenter cohort study (Predicting and Preventing Postconcussive Problems in Pediatrics [5P]) enrolled young patients (aged 5-<18 years) who presented within 48 hours of an acute head injury at 1 of 9 pediatric emergency departments within the Pediatric Emergency Research Canada (PERC) network from August 2013 through September 2014 (derivation cohort) and from October 2014 through June 2015 (validation cohort)...
March 8, 2016: JAMA: the Journal of the American Medical Association
Randolph W Evans, Kamalika Ghosh
BACKGROUND: Two prior studies have shown an increased prevalence of migraine among physicians who are headache medicine specialists (HMS). There have been no studies of the prevalence of other headache disorders among HMS. A prior survey showed that neurologists like to treat some headaches more than others but there has not been a similar survey of HMS. OBJECTIVES: The aim of the survey was to learn more about the prevalence of headaches among HMS and which headache disorders they like to treat...
March 2016: Headache
Charles H Tator, Hannah S Davis, Paul A Dufort, Maria Carmella Tartaglia, Karen D Davis, Ahmed Ebraheem, Carmen Hiploylee
OBJECTIVE The objective of this study was to determine the demographics and predictors of postconcussion syndrome (PCS) in a large series of patients using a novel definition of PCS. METHODS The authors conducted a retrospective cohort study of 284 consecutive concussed patients, 221 of whom had PCS on the basis of at least 3 symptoms persisting at least 1 month. This definition of PCS was uniformly employed and is unique in accepting an expanded list of symptoms, in shortening the postconcussion interval to 1 month from 3 months, and in excluding those with focal injuries such as hemorrhages and contusions...
November 2016: Journal of Neurosurgery
Joseph H Miller, Clarence Gill, Elizabeth N Kuhn, Brandon G Rocque, Joshua Y Menendez, Jilian A O'Neill, Bonita S Agee, Steven T Brown, Marshall Crowther, R Drew Davis, Drew Ferguson, James M Johnston
OBJECT Pediatric sports-related concussions are a growing public health concern. The factors that determine injury severity and time to recovery following these concussions are poorly understood. Previous studies suggest that initial symptom severity and diagnosis of attention deficit hyperactivity disorder (ADHD) are predictors of prolonged recovery (> 28 days) after pediatric sports-related concussions. Further analysis of baseline patient characteristics may allow for a more accurate prediction of which patients are at risk for delayed recovery after a sports-related concussion...
April 2016: Journal of Neurosurgery. Pediatrics
Geoffrey L Heyer, Julie A Young, Sean C Rose, Kelly A McNally, Anastasia N Fischer
OBJECTIVE: The term "post-traumatic migraine" (PTM) has been used to describe post-traumatic headaches (PTHs) that have associated migraine features, but studies of this relationship are lacking. The objective of the present study was to determine whether PTH correlates strongly with migraine symptoms among youth with concussion. METHODS: Twenty-three symptoms were analyzed from a retrospective cohort of 1953 pediatric patients with concussion. A principal component analysis (PCA) with oblique Promax rotation was conducted to explore underlying symptom relationships in the full cohort and in subcohorts stratified by the presence (n = 414) or absence (n = 1526) of premorbid headache...
April 2016: Cephalalgia: An International Journal of Headache
Clinton D Morgan, Scott L Zuckerman, Young M Lee, Lauren King, Susan Beaird, Allen K Sills, Gary S Solomon
OBJECT Sport-related concussion (SRC) is a major public health problem. Approximately 90% of SRCs in high school athletes are transient; symptoms recover to baseline within 1 week. However, a small percentage of patients remain symptomatic several months after injury, with a condition known as postconcussion syndrome (PCS). The authors aimed to identify risk factors for PCS development in a cohort of exclusively young athletes (9-18 years of age) who sustained SRCs while playing a sport. METHODS The authors conducted a retrospective case-control study by using the Vanderbilt Sports Concussion Clinic database...
June 2015: Journal of Neurosurgery. Pediatrics
Ronald G Riechers, Mark F Walker, Robert L Ruff
Chronic pain, especially headache, is an exceedingly common complication of traumatic brain injury (TBI). In fact, paradoxically, the milder the TBI, the more likely one is to develop headaches. The environment of injury and the associated comorbidities can have a significant impact on the frequency and severity of headaches and commonly serve to direct management of the headaches. Trauma likely contributes to the development of headaches via alterations in neuronal signaling, inflammation, and musculoskeletal changes...
2015: Handbook of Clinical Neurology
Elana Pinchefsky, Alexander Sasha Dubrovsky, Debbie Friedman, Michael Shevell
BACKGROUND: Brain injury is one of the most common injuries in the pediatric age group, and post-traumatic headache is one of the most common symptoms following mild traumatic brain injury in children. METHODS: This is an expert opinion-based two-part review on pediatric post-traumatic headaches. Part I will focus on an overview and approach to the evaluation of post-traumatic headache. Part II will focus on the medical management of post-traumatic headache. Relevant articles were reviewed, and an algorithm is proposed...
March 2015: Pediatric Neurology
James M Lynch, Megan Anderson, Brooke Benton, Sue Stanley Green
OBJECTIVE: To present the case of 2 adolescent high school student-athletes who developed postconcussion syndrome with protracted and limiting visual complaints that markedly affected academic, social, and athletic activity for a year after the onset of symptoms. Both had significant improvement soon after a unique intervention was administered. BACKGROUND: A 14-year-old female soccer and softball player sustained 2 concussions in the same week. She had persistent symptoms for a year that affected her grades and precluded athletic participation...
March 2015: Journal of Athletic Training
Danielle Steilen, Ross Hauser, Barbara Woldin, Sarah Sawyer
The use of conventional modalities for chronic neck pain remains debatable, primarily because most treatments have had limited success. We conducted a review of the literature published up to December 2013 on the diagnostic and treatment modalities of disorders related to chronic neck pain and concluded that, despite providing temporary relief of symptoms, these treatments do not address the specific problems of healing and are not likely to offer long-term cures. The objectives of this narrative review are to provide an overview of chronic neck pain as it relates to cervical instability, to describe the anatomical features of the cervical spine and the impact of capsular ligament laxity, to discuss the disorders causing chronic neck pain and their current treatments, and lastly, to present prolotherapy as a viable treatment option that heals injured ligaments, restores stability to the spine, and resolves chronic neck pain...
2014: Open Orthopaedics Journal
Thomas R Terrell, Roberd Bostick, Jeffrey Barth, Richard Sloane, Robert C Cantu, Ellen Bennett, Leslie Galloway, Daniel Laskowitz, Dave Erlanger, Doug McKeag, Verle Valentine, Gregory Nichols
BACKGROUND: Approximately 3.8 million sports related TBIs occur per year. Genetic variation may affect both TBI risk and post-TBI clinical outcome. Limited research has focused on genetic risk for concussion among athletes. We describe the design, methods, and baseline characteristics of this prospective cohort study designed to investigate a potential association between genetic polymorphisms of apolipoprotein E gene, APOE promoter G-219T, and Tau gene exon 6 polymorphisms (Ser53 Pro and Hist47Tyr) with: 1) the risk of prospective concussion; 2) concussion severity; and 3) postconcussion neurocognitive recovery...
January 2017: Journal of Sports Medicine and Physical Fitness
Christopher C Giza, David A Hovda
Since the original descriptions of postconcussive pathophysiology, there has been a significant increase in interest and ongoing research to study the biological underpinnings of concussion. The initial ionic flux and glutamate release result in significant energy demands and a period of metabolic crisis for the injured brain. These physiological perturbations can now be linked to clinical characteristics of concussion, including migrainous symptoms, vulnerability to repeat injury, and cognitive impairment...
October 2014: Neurosurgery
Charles H Tator, Hannah Davis
BACKGROUND: There are still many unanswered questions about postconcussion syndrome (PCS) in sports and recreation. The predictors of PCS are unknown, although a history of previous concussion has been suspected. OBJECTIVE: To explore the clinical features and demography of PCS in athletes. METHODS: A retrospective cohort study was performed by chart review of clinical and demographic data of 285 consecutive concussed patients, 138 of whom had sports-related PCS based on ≥ 3 postconcussion symptoms lasting ≥ 1 month...
October 2014: Neurosurgery
Randolph W Evans
Posttraumatic headaches are one of the most common and controversial secondary headache types. After mild head injury, more than 50% of people develop a postconcussion syndrome which has been controversial for more than 150 years. Headache is estimated as present in 30% to 90% of patients after mild head injury. Most headaches are of the tension type, although migraines can increase in frequency or occur acutely or chronically de novo. A review is provided of headaches in civilians, soldiers after blast trauma, athletes, and post-craniotomy including pathogenesis...
May 2014: Neurologic Clinics
Teshamae S Monteith, David Borsook
Despite the growing awareness of mild traumatic brain injury in military and civilian populations, understanding of the acute and chronic effects of concussion on central nervous system structure and function is limited. Even less is understood about the underpinnings of the cardinal postconcussive symptom, post-traumatic headache (PTH). Here, we review recent advances in PTH, with special emphasis on the migraine-like phenotype, the most disabling form. Considerations for future research in PTH are discussed, including diagnostic classification, and applications with advanced neuroimaging techniques, biomarkers, and treatments...
February 2014: Current Neurology and Neuroscience Reports
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