A Majority of Postconcussive Headaches in Children Are Migraines

Contrary to previously published reports, most postconcussive headaches in children are migraine,

not tension-type headache.


NEW ORLEANS—More than two-thirds of postconcussive headaches in children are classified as migraines, according to research presented at the 64th Annual Meeting of the American Academy of Neurology.

“Migraines comprise a far greater percentage of postconcussive headaches than previously reported,” said John A. Pugh, MD, PhD, of the Cincinnati Children’s Hospital Medical Center, and colleagues.

Prior studies have indicated that tension headaches were the most prevalent type of headache seen after a concussion, but that conclusion was “at odds with our personal experience,” stated the researchers.

To better classify postconcussive headaches in children, the investigators retrospectively reviewed the charts of 104 patients ages 10 to 21 who were seen at the Cincinnati Children’s Hospital Medical Center Concussion Clinic between January 2008 and June 2011.

The 75 patients included in the analysis (58% male) presented within three months following a concussion and had a mean age of 14.7. Data were gathered on patients’ medical history, circumstances surrounding the concussion, and predominant headache type according to International Classification of Headache Disorders (ICHD)-II criteria, which categorize headaches as migraine, tension, or other.

Headache was the most commonly reported postconcussive symptom (91%), and migraine was the most prevalent ICHD-II headache classification (69%), followed by tension headache (22%) and unclassifiable headache (9%).

“The only personal or family history that predicted the occurrence of postconcussive headache was a personal history of headaches prior to concussion,” Dr. Pugh’s group commented.

A majority of concussions (85%) in adolescents were attributable to sporting activities such as football, basketball, and soccer. Ninety-three percent of patients played at least one sport, and 23% played three or more sports, the investigators noted. However, a significant minority of concussions were sustained from vehicular accidents rather than sports.

Dr. Pugh and his colleagues also classified concussions per American Academy of Neurology grade, finding that 46% of concussions were grade II, 27% were grade I, and 27% were grade III. Sixteen patients (22%) had a history of at least one prior concussion.

“This finding has significant implications for understanding the pathophysiology of postconcussive headaches as well as their management,” they concluded.

—Lauren LeBano

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