Division of Pediatric Emergency Medicine, McGill University Health Center - Montreal Children's Hospital, Montreal, Quebec, Canada; Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
Headache. 2014 May;54(5):878-87. doi: 10.1111/head.12334. Epub 2014 Apr 2.
This study's objective is to characterize the therapeutic effect of peripheral nerve blocks of the scalp for children and adolescents with post-traumatic headaches.
Headaches are the most frequently reported persistent symptoms following a pediatric mild traumatic brain injury, may be challenging to treat, and can transform into debilitating chronic headaches. The beneficial use of peripheral nerve blocks of the scalp has been reported for adults with post-traumatic headaches.
Retrospective case series on all patients <18 years of age treated between January 2012 and June 2013 in the mild traumatic brain injury clinic with a nerve block. The main outcome measure was the proportion of patients with a good therapeutic effect, defined by the duration of the block being >24 hours and/or repeat blocks requested. A data extractor blinded to main outcome measures performed the chart review. A patient satisfaction survey was also sent to all patients to assess the recalled experience with the interventions received.
A total of 62 nerve blocks were performed on 28 patients for 30 injuries that led to post-traumatic headaches. The mean (standard deviation) age was 14.6 (1.7) years. The first nerve blocks were performed a mean (standard deviation) of 70 (54.2) days post-injury. The therapeutic effect was good in 93% of patients with 71% reporting immediate complete relief of their headaches; the mean percent headache reduction was 94%. Most (91%) would recommend a nerve block for post-traumatic headaches.
The ease with which peripheral nerve blocks of the scalp can be performed combined with the immediate relief experienced by patients makes them a potential addition to the armamentarium of headache management strategies for children and adolescent with post-traumatic headaches.
本研究旨在描述头皮外周神经阻滞治疗儿童和青少年创伤后头痛的疗效。
头痛是儿童轻度创伤性脑损伤后最常报告的持续性症状，可能难以治疗，并可能转化为致残性慢性头痛。头皮外周神经阻滞对创伤后头痛的成人有益。
回顾性病例系列研究，纳入 2012 年 1 月至 2013 年 6 月间在轻度创伤性脑损伤诊所接受神经阻滞治疗的所有<18 岁患者。主要结局指标是治疗效果良好的患者比例，定义为阻滞持续时间>24 小时和/或要求重复阻滞。数据提取器对主要结局指标进行盲法评估。还向所有患者发送了患者满意度调查，以评估他们对接受的干预措施的回忆体验。
共对 28 例 30 例创伤后头痛患者进行了 62 次神经阻滞。平均（标准差）年龄为 14.6（1.7）岁。首次神经阻滞在损伤后平均（标准差）70（54.2）天进行。93%的患者治疗效果良好，71%的患者头痛立即完全缓解，头痛缓解率平均为 94%。大多数（91%）患者会推荐神经阻滞治疗创伤后头痛。
头皮外周神经阻滞操作简便，患者即刻缓解头痛，因此对于创伤后头痛的儿童和青少年头痛管理策略，它们可能是一种潜在的附加治疗方法。
