Headache in traumatic brain injuries from blunt head trauma

Peter S. Dayan, James F Holmes Jr, John Hoyle, Shireen Atabaki, Michael G. Tunik, Richard Lichenstein, Michelle Miskin, Nathan Kuppermann

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

OBJECTIVE: To determine the risk of traumatic brain injuries (TBIs) in children with headaches after minor blunt head trauma, particularly when the headaches occur without other findings suggestive of TBIs (ie, isolated headaches). METHODS: This was a secondary analysis of a prospective observational study of children 2 to 18 years with minor blunt head trauma (ie, Glasgow Coma Scale scores of 14-15). Clinicians assessed the history and characteristics of headaches at the time of initial evaluation, and documented findings onto case report forms. Our outcome measures were (1) clinically important TBI (ciTBI) and (2) TBI visible on computed tomography (CT). RESULTS: Of 27 495 eligible patients, 12 675 (46.1%) had headaches. Of the 12 567 patients who had complete data, 2462 (19.6%) had isolated headaches. ciTBIs occurred in 0 of 2462 patients (0%; 95% confidence interval [CI]: 0%-0.1%) in the isolated headache group versus 162 of 10 105 patients (1.6%; 95% CI: 1.4%-1.9%) in the nonisolated headache group (risk difference, 1.6%; 95% CI: 1.3%-1.9%). TBIs on CT occurred in 3 of 456 patients (0.7%; 95% CI: 0.1%-1.9%) in the isolated headache group versus 271 of 6089 patients (4.5%; 95% CI: 3.9%-5.0%) in the nonisolated headache group (risk difference, 3.8%; 95% CI: 2.3%-4.5%). We found no significant independent associations between the risk of ciTBI or TBI on CT with either headache severity or location. CONCLUSIONS: ciTBIs are rare and TBIs on CT are very uncommon in children with minor blunt head trauma when headaches are their only sign or symptom.

Original languageEnglish (US)
Pages (from-to)504-512
Number of pages9
JournalPediatrics
Volume135
Issue number3
DOIs
StatePublished - Mar 1 2015

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Craniocerebral Trauma
Headache
Confidence Intervals
Tomography
Traumatic Brain Injury
Glasgow Coma Scale
Signs and Symptoms
Observational Studies
History
Outcome Assessment (Health Care)
Prospective Studies

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Dayan, P. S., Holmes Jr, J. F., Hoyle, J., Atabaki, S., Tunik, M. G., Lichenstein, R., ... Kuppermann, N. (2015). Headache in traumatic brain injuries from blunt head trauma. Pediatrics, 135(3), 504-512. https://doi.org/10.1542/peds.2014-2695

Headache in traumatic brain injuries from blunt head trauma. / Dayan, Peter S.; Holmes Jr, James F; Hoyle, John; Atabaki, Shireen; Tunik, Michael G.; Lichenstein, Richard; Miskin, Michelle; Kuppermann, Nathan.

In: Pediatrics, Vol. 135, No. 3, 01.03.2015, p. 504-512.

Research output: Contribution to journalArticle

Dayan, PS, Holmes Jr, JF, Hoyle, J, Atabaki, S, Tunik, MG, Lichenstein, R, Miskin, M & Kuppermann, N 2015, 'Headache in traumatic brain injuries from blunt head trauma', Pediatrics, vol. 135, no. 3, pp. 504-512. https://doi.org/10.1542/peds.2014-2695
Dayan PS, Holmes Jr JF, Hoyle J, Atabaki S, Tunik MG, Lichenstein R et al. Headache in traumatic brain injuries from blunt head trauma. Pediatrics. 2015 Mar 1;135(3):504-512. https://doi.org/10.1542/peds.2014-2695
Dayan, Peter S. ; Holmes Jr, James F ; Hoyle, John ; Atabaki, Shireen ; Tunik, Michael G. ; Lichenstein, Richard ; Miskin, Michelle ; Kuppermann, Nathan. / Headache in traumatic brain injuries from blunt head trauma. In: Pediatrics. 2015 ; Vol. 135, No. 3. pp. 504-512.
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AU - Dayan, Peter S.

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AU - Miskin, Michelle

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N2 - OBJECTIVE: To determine the risk of traumatic brain injuries (TBIs) in children with headaches after minor blunt head trauma, particularly when the headaches occur without other findings suggestive of TBIs (ie, isolated headaches). METHODS: This was a secondary analysis of a prospective observational study of children 2 to 18 years with minor blunt head trauma (ie, Glasgow Coma Scale scores of 14-15). Clinicians assessed the history and characteristics of headaches at the time of initial evaluation, and documented findings onto case report forms. Our outcome measures were (1) clinically important TBI (ciTBI) and (2) TBI visible on computed tomography (CT). RESULTS: Of 27 495 eligible patients, 12 675 (46.1%) had headaches. Of the 12 567 patients who had complete data, 2462 (19.6%) had isolated headaches. ciTBIs occurred in 0 of 2462 patients (0%; 95% confidence interval [CI]: 0%-0.1%) in the isolated headache group versus 162 of 10 105 patients (1.6%; 95% CI: 1.4%-1.9%) in the nonisolated headache group (risk difference, 1.6%; 95% CI: 1.3%-1.9%). TBIs on CT occurred in 3 of 456 patients (0.7%; 95% CI: 0.1%-1.9%) in the isolated headache group versus 271 of 6089 patients (4.5%; 95% CI: 3.9%-5.0%) in the nonisolated headache group (risk difference, 3.8%; 95% CI: 2.3%-4.5%). We found no significant independent associations between the risk of ciTBI or TBI on CT with either headache severity or location. CONCLUSIONS: ciTBIs are rare and TBIs on CT are very uncommon in children with minor blunt head trauma when headaches are their only sign or symptom.

AB - OBJECTIVE: To determine the risk of traumatic brain injuries (TBIs) in children with headaches after minor blunt head trauma, particularly when the headaches occur without other findings suggestive of TBIs (ie, isolated headaches). METHODS: This was a secondary analysis of a prospective observational study of children 2 to 18 years with minor blunt head trauma (ie, Glasgow Coma Scale scores of 14-15). Clinicians assessed the history and characteristics of headaches at the time of initial evaluation, and documented findings onto case report forms. Our outcome measures were (1) clinically important TBI (ciTBI) and (2) TBI visible on computed tomography (CT). RESULTS: Of 27 495 eligible patients, 12 675 (46.1%) had headaches. Of the 12 567 patients who had complete data, 2462 (19.6%) had isolated headaches. ciTBIs occurred in 0 of 2462 patients (0%; 95% confidence interval [CI]: 0%-0.1%) in the isolated headache group versus 162 of 10 105 patients (1.6%; 95% CI: 1.4%-1.9%) in the nonisolated headache group (risk difference, 1.6%; 95% CI: 1.3%-1.9%). TBIs on CT occurred in 3 of 456 patients (0.7%; 95% CI: 0.1%-1.9%) in the isolated headache group versus 271 of 6089 patients (4.5%; 95% CI: 3.9%-5.0%) in the nonisolated headache group (risk difference, 3.8%; 95% CI: 2.3%-4.5%). We found no significant independent associations between the risk of ciTBI or TBI on CT with either headache severity or location. CONCLUSIONS: ciTBIs are rare and TBIs on CT are very uncommon in children with minor blunt head trauma when headaches are their only sign or symptom.

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