Langdon Raquel, Taraman Sharief
Pediatr Ann. 2018 Feb 1;47(2):e61-e68. doi: 10.3928/19382359-20180131-01.
After sustaining a concussion or mild traumatic brain injury, headaches are one of the most common complaints. The pathophysiologic changes that occur in the setting of injury likely contribute to or cause posttraumatic headaches. Posttraumatic headaches often present as migraine or tension-type headaches. Unlike pain from other types of injuries, headaches following mild traumatic brain injury are more likely to persist. Preexisting conditions such as migraine and mood disorders may influence posttraumatic headache and complicate management. Patients are at high risk to overuse abortive medications and develop medication overuse headache. Headache hygiene and early education are essential for effective management. Abortive medications include nonsteroidal anti-inflammatory drugs and triptans. Preventive medications include tricyclic antidepressants and antiepileptics. Patients who fail outpatient therapies may benefit from referral for intravenous medications in the emergency department. Patients with persistent posttraumatic headache may benefit from multimodal treatments including physical rehabilitation and pain-focused cognitive-behavioral therapies. [Pediatr Ann. 2018;47(2):e61-e68.].
在遭受脑震荡或轻度创伤性脑损伤后，头痛是最常见的主诉之一。损伤情况下发生的病理生理变化可能导致或引发创伤后头痛。创伤后头痛通常表现为偏头痛或紧张型头痛。与其他类型损伤引起的疼痛不同，轻度创伤性脑损伤后的头痛更有可能持续存在。偏头痛和情绪障碍等既往疾病可能影响创伤后头痛并使治疗复杂化。患者过度使用缓解药物并发展为药物过度使用性头痛的风险很高。头痛卫生和早期教育对有效治疗至关重要。缓解药物包括非甾体类抗炎药和曲坦类药物。预防性药物包括三环类抗抑郁药和抗癫痫药。门诊治疗失败的患者可能会从急诊科静脉用药转诊中获益。持续性创伤后头痛的患者可能会从包括物理康复和以疼痛为重点的认知行为疗法在内的多模式治疗中获益。[《儿科年鉴》。2018年；47(2):e61 - e68。]
