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Kids Korner: Post-Concussion Headaches

By Joel S. Brenner, M.D.
Pediatric Sports Medicine and Adolescent Medicine Specialist, Children’s Hospital of The King’s Daughters, Norfolk, Virginia

Parent: My son suffered a concussion during his football game last week and now he’s having a recurring headache.
Doctor: Tell me, what other symptoms is he having?
Parent: He complains of being tired, that sunlight and loud music bother him, and that he has difficulty concentrating in school. He also says the headache gets worse whenever he is trying to do schoolwork, read or watch television. What should we do?

Headaches after a concussion are the most commonly reported symptom and can be debilitating. They are more common in individuals with a history of migraine headaches, but can occur in those without any previous history of headaches.

Patients with post-concussion headaches often describe the pain as a “pressure” or a “pulsating” feeling. The pain is often felt in the same place on the head where the impact took place, but is usually in the forehead or side of the head. The headache is often accompanied by sensitivity to light and/or sound. In addition, the patient may feel dizzy and nauseated, especially during the headaches. Parents may also notice that their child’s personality is affected, becoming more irritable or short-tempered (more than a typical teenager).

It is common for children with post-concussion headache to complain that the headache gets worse at the end of the school day and while trying to concentrate in class, read, watch television, work on the computer or even while texting. The headache is often exacerbated by physical activity, such as walking, running or biking. Other factors that can make the headache worse include loud public events (sporting games or concerts), excessive caffeine consumption, driving or drinking alcohol.

Post-concussion headaches can be persistent and take weeks to months (in extreme cases) to completely resolve. Fortunately, most of these headaches resolve spontaneously with rest and minimal pharmacological treatment.

Treating Post-Concussion Headache

Cognitive and physical rest immediately after the injury are extremely important. If the child ignores his symptoms and tries to “tough it out,” it can delay the recovery process. Resting the brain and the body needs to last as long as the headaches and other symptoms occur.

Cognitive rest means the child may need to stay out of school, part- or full-time, if the headache is persistent. As symptoms improve and there are pain-free periods, the child should be allowed to return to school for half days until he can complete the entire school day without developing a headache. Academic accommodations should be put into place with the help of the school’s guidance counselor, teachers and principal, if needed. These accommodations include having extended time for classroom assignments and homework, postponement of quizzes or exams, and prewritten class notes. The child should also be allowed to put his head down in class if he experiences a headache or be allowed to go to the nurse’s office to rest and take a medication.

Physical rest means limiting physical exertion. Walking should be limited to activities of daily living (e.g., going to school). The child should be excused from physical education class and recess and be discouraged from running, dancing, strength training or any other athletic activity during the recovery period. This will not only help with the headache, but will aid in the prevention of “second impact syndrome,” which develops when a second brain injury occurs prior to complete recovery from the first.

The most important “medicine” is sleep. Encouraging a minimum of eight hours of sleep each night can facilitate the recovery process by allowing the brain to heal.

Pharmacological treatments can also be beneficial if used properly. Over-the-counter (OTC) medications such as acetaminophen or naproxen sodium may be helpful if used for a limited period of time, unless otherwise directed by your healthcare provider. Overusing OTCs can lead to “analgesic overuse” headache and actually make the problem worse. Aspirin products should be avoided in children. Prescription medications such as naproxen, amitriptyline or topiramate can be helpful for some patients, but need to be monitored by a healthcare provider.

Post-concussion headaches are common and debilitating. They can last anywhere from a few days to weeks and even months. How long they linger depends on many factors, but the most important is how quickly treatment is begun after injury.

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