McConnell Blake, Duffield Tyler, Hall Trevor, Piantino Juan, Seitz Dylan, Soden Daniel, Williams Cydni
School of Medicine, Oregon Health and Science University, Portland, OR, USA.
Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA.
J Child Neurol. 2020 Jan;35(1):63-70. doi: 10.1177/0883073819876473. Epub 2019 Oct 4.
Post-traumatic headache is common after pediatric traumatic brain injury and affects thousands of children every year, but little is known about how headache affects recovery after traumatic brain injury in other symptom domains. We aimed to determine the association between headache and other common symptoms after pediatric traumatic brain injury and explore whether subjective complaints of headache are associated with objective deficits on specialized neurocognitive testing. We conducted a retrospective cohort study of children ages 3-19 years following traumatic brain injury with a completed Sports Concussion Assessment Tool (SCAT) questionnaire. Post-traumatic headache was defined by a score more than 2 on the SCAT question for headache and define headache groups for comparison. In our cohort, we analyzed data from the Delis-Kaplan Executive Function System and the Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II). Headache was reported in 40 (33%) patients presenting for post-traumatic brain injury care among 121 pediatric traumatic brain injury patients and did not differ by injury severity. Median total SCAT symptom score in the headache group was 5-fold higher compared to patients without headache (median 45.5 vs 9; < .001). Significantly lower-scaled scores in color naming, matrix reasoning, letter sequencing, and letter switching were also found in the headache group (all ≤ .03). Our study shows that headache, as reported by patients on the SCAT, is associated with higher symptom scores in all other symptom domains, including sleep, mood, sensory, and cognitive. Headache was also associated with worse objective neurocognitive measures and may identify patients who could benefit from specialized follow-up care and management.
创伤后头痛在儿童创伤性脑损伤后很常见，每年影响成千上万的儿童，但对于头痛如何影响创伤性脑损伤后其他症状领域的恢复却知之甚少。我们旨在确定儿童创伤性脑损伤后头痛与其他常见症状之间的关联，并探讨头痛的主观主诉是否与专门神经认知测试中的客观缺陷相关。我们对3至19岁创伤性脑损伤后完成了运动性脑震荡评估工具（SCAT）问卷的儿童进行了一项回顾性队列研究。创伤后头痛由SCAT头痛问题得分超过2来定义，并定义头痛组以进行比较。在我们的队列中，我们分析了来自德利斯-卡普兰执行功能系统和韦氏儿童智力量表第二版（WASI-II）的数据。在121名儿童创伤性脑损伤患者中，有40名（33%）因创伤性脑损伤护理前来就诊的患者报告有头痛，且头痛与损伤严重程度无关。头痛组的SCAT总症状评分中位数比无头痛患者高5倍（中位数45.5对9；<0.001）。头痛组在颜色命名、矩阵推理、字母排序和字母转换方面的得分也显著较低（均≤0.03）。我们的研究表明，患者在SCAT上报告的头痛与所有其他症状领域的较高症状评分相关，包括睡眠、情绪、感觉和认知。头痛还与较差的客观神经认知指标相关，可能识别出可从专门的后续护理和管理中受益的患者。
