The most common types of headaches in children and adolescents
are migraines and stress-related headaches. Headaches can also be
seen with fever, the flu, and acute respiratory infections. This
document reviews many of the less frequently seen headaches that
occur in children and adolescents. The order of presentation of the
different headache types discussed in this document is consistent
with the frequency with which these headaches types occur.
Post-traumatic headache
Head injuries account for a
large number of emergency department visits by children. Children
and adolescents who are involved in motor vehicle accidents,
bicycle accidents, sports-related injuries, or child abuse may
develop a headache syndrome within minutes to days following the
incident, even after what would seem to be a trivial head
injury.
Patients with post-traumatic headache often have other symptoms
including dizziness, vertigo, difficulty concentrating, memory
disorders, depression, altered school performance, behavior
disorders, and sleep alteration. This collection of symptoms
together with headache is commonly called post-concussion syndrome.
Importantly, the severity of the symptoms does not depend on the
severity of the head injury.
The headaches associated with the post-concussion syndrome can
be similar to a migraine headache (occurring intermittently with
nausea or vomiting or daily), a tension-type headache, or both.
Most patients who are hospitalized for a mild to moderate head
injury receive some form of neuroimaging -- either computed
tomography (CT) or magnetic resonance imaging (MRI). However, the
absence of abnormality on MRI or CT does not predict whether a
patient will develop post-traumatic headaches or postconcussion
syndrome.
Following mild head injury, functional recovery generally occurs
in the following order: attention and concentration deficits
usually resolve within 6 weeks; visual memory, imagination, and
analytic capacity do not begin to resolve for at least 6 weeks;
verbal memory, abstraction, cognition and information processing
speed can take more than 12 weeks to recover. Although most
children have clinical improvement of their headache within several
weeks, and almost all within 3 to 6 months, some patients continue
to experience headache and the associated symptoms of
post-concussion syndrome.
Post-traumatic headache treatment is symptomatic. The initial
headache symptoms and soft tissue injuries may be effectively
treated with mild analgesics and nonsteroidal anti-inflammatory
drugs over the initial weeks. If there is associated cervical soft
tissue symptoms, a short course of physical therapy might be of
benefit. If more prominent headache symptoms or associated symptoms
of anxiety, depression, or cognitive difficulties are present, more
aggressive intervention may be necessary. Post-traumatic headache
usually responds to the medications that are used for chronic
headache and chronic tension-type headache, although no specific
medication or treatment protocol has been found that will alter the
underlying central nervous system disturbance. Tricyclic
antidepressants, such as amitriptyline or nortriptyline, are often
the medications of choice. To avoid rebound headaches, analgesic
use should be limited to no more than twice a week.