Acute and Chronic Management of Posttraumatic Headache in Children

A Systemic Review

Carlyn Patterson Gentile MD, PhD; Ryan Shah BS; Samantha L. Irwin MSc, MB, BCh, BAO, FRCPC; Kaitlin Greene MD; Christina L. Szperka MD, MSCE, FAHS


Headache. 2021;61(10):1475-1492. 

In This Article


This systematic review preregistered protocol can be found on the Prospero database (ID CRD42020198703). PRISMA guidelines were followed,[15] except in the subgrouping of results to streamline integrating results within multiple treatment categories. Studies that met the following criteria were included: (1) at least 50% of subjects were younger than 18 years old, (2) acute (<3 months) and/or persistent (≥3 months) PTH of any phenotype was evaluated, (3) headache treatment response was reported, (4) sample size was >1, (5) written in English, and (6) published between 1985 and 2021. Headache features and duration were considered. We included peer-reviewed studies of a broad range of research designs given the limited research on the treatment of pediatric PTH. Papers that solely discussed diagnosis, evaluation tools, epidemiology, return to play or return to learn but not treatment were excluded. Review and opinion articles were also excluded, but one reviewer examined references to screen for additional articles that met inclusion criteria.

Our literature search strategy was designed to target four key concepts: (1) child and adolescent, (2) posttraumatic, (3) headache, and (4) treatment. Queries of PubMed, Embase, Scopus, and Cochrane review search engines were conducted on July 16, 2020 and May 3, 2021. Details of the search strategy can be found in the Appendix.

After duplicates were removed, two review authors independently screened the titles and abstracts of the search results for the inclusion and exclusion criteria. Information from the abstract search was saved in a Microsoft Excel® spreadsheet, and software generated in Matlab® was used to identify duplicates. Two authors independently extracted data from the selected studies and entered it into REDCap®, an electronic data management program, and each article was assessed for quality. We integrated the data as a descriptive synthesis rather than a meta-analysis due to the limited studies available. Study design type, as well as checklists provided by the National Institutes of Health (NIH) Quality Assessment Tools (, which were specific to study type, were used to rank the data as "good," "fair," or "poor" based on prior reports that have used this tool[16] (Table 1).

Disagreements were reconciled by a third author. Data extraction included study information and characteristics, the therapeutic agent used, and outcomes assessed. Subject characteristics included headache features, family and personal history of migraine, details of treatment, and time from concussion to treatment were collected when available.

The main outcome measure was improvement of headache. This was intentionally broad to capture as many articles as possible that comment on change in PTH related to an intervention. This included subjective improvement in headache, change in headache severity and/or frequency, improvement in migrainous features (i.e., photophobia, phonophobia, and nausea), and headache-related disability.