In a study published on March 8, 2021, in the Journal of the American Medical Association (JAMA), researchers from the Four Corners Youth Consortium, a group of doctors and scientists who are researching youth concussion, sought to unravel how the type of headache experienced by pediatric patients with concussion may be a factor in how quickly they recover. The team evaluated the recovery time of nearly 300 adolescents ages 5 to 18 who visited a traumatic brain injury (TBI) clinic during a span of roughly 1.5 years. All had been diagnosed with a concussion, and the research team tracked their recovery over three months. They found that after sustaining a concussion, kids who had post-traumatic headaches (PTH) took longer to recover than kids who did not. Kids who had PTH that were characteristic of migraine — moderate to severe intensity, with sensitivity to light or sound, or nausea — took longer to recover than kids who had headaches that were not migraine. According to Joshua Kamins, MD, a neurologist in the UCLA David Geffen School of Medicine’s Goldberg Migraine Program in Los Angeles, who led the study, the most striking finding was that there was no difference in recovery time among girls and boys who experienced the same degree of headache. But because females are three times more likely to have migraines than males, according to the Migraine Research Foundation, they are also more likely than males to have prolonged recovery time after a concussion. RELATED: How Concussions Affect Males and Females Differently “We have known for some time that a major risk factor for prolonged recovery after concussion is being female, but we have never understood the reason,” says Dr. Kamins. “This creates a great opportunity to provide targeted treatment and to eliminate a major source of gender disparity in concussion recovery.” According to Juliana VanderPluym, MD, a neurologist at the Mayo Clinic in Phoenix who was not involved with the new study, physicians can also use this information to better predict how long patients will take to recover from a concussion. “One of the main questions that patients and families ask is, ‘When am I going to feel better?’” says Dr. VanderPluym. The results of the study can’t help doctors predict the exact date a patient will recover, she says, but can provide critical information they can use to estimate who may take longer. It also sheds light on how patients are being treated for their symptoms. “As of now, there is no clear guidance for which are the best treatments for PTH and when they should be started after a concussion,” says VanderPluym. “The data show a few trends that need to be explored further, such as why less than half of concussions with PTH were recommended for acute treatment such as rescue medication to take when they have a headache, which would reduce symptoms in the moment. Moving forward, we will need to understand why so few pediatric patients get treatments for their PTH and most importantly what treatments would be the best for them.” The study found that, among those to whom acute treatment was recommended, very few were prescribed migraine-specific treatments, despite migrainous headaches being more common than other headache types. Even fewer patients who had concussions with PTH were recommended preventive treatments that would reduce the frequency and severity of headaches. According to VanderPluym, this could be due to the lack of research that has sought to understand pediatric headache, migraine, and concussion. “It’s important to study the pediatric population separately because children are not just mini adults, says VanderPluym, adding that the migraine symptoms that children and adolescents experience often differ from the hallmarks of adult migraine, and the treatments that work differ in the populations as well. According to the American Migraine Foundation, migraine in kids may be shorter and occur less often than in adults. Previous studies, including one published in January 2017 in the New England Journal of Medicine, have also shown that kids respond well to nonpharmaceutical migraine strategies, like headache education. But migrainous PTH may require different treatment. “We also do not have as much information about how they respond to medications, as most drug trials exclude children,” says Dr. Kamins. RELATED: Resources for People Living With Migraine or Headache According to the Centers for Disease Control and Prevention (CDC), concussions are easy injuries to heal from for the majority of kids, and recovery time usually takes around two weeks. But around 20 percent of kids who have had a concussion experience persistent symptoms that last months or even years, Kamins says. “The findings of this study create an opportunity to help kids who are at risk for prolonged recovery to get better faster by intervening early or referring them to headache and concussion specialists sooner,” says Kamins, noting that more research on the topic is in the works.
