Headache long after pediatric concussion: presence, intensity, interference, and association with cognition

ABSTRACT

Objective: Document headache presence, intensity, and interference after concussion(s), as well as examine its association with cognition.

Participants: Participants 8–19 years of age were assessed on average 34 months (SD = 21.5) after an orthopedic injury (OI, n = 29), single concussion (n = 21), or multiple concussions (n = 15).

Measures: Headache intensity was rated using the Headache Rating Scale and headache interference was rated using the Post-Concussion Symptom Inventory (PCSI). Cognition was rated using the PCSI and measured using CNS Vital Signs.

Results: Type of injury did not differ significantly in headache presence or intensity. However, there was a dose–response relationship found for children’s ratings of headache interference, which was rated highest among children with multiple concussions, intermediate among those with single concussion, and lowest among children with OI. Both headache intensity and interference ratings correlated significantly with self and parent ratings of cognition on the PCSI, but not with cognitive test performance.

Conclusions: Youth with single or multiple concussions report greater headache interference – but not higher headache intensity – compared to youth without concussion. Although higher headache intensity and interference were associated with more self-reported cognitive symptoms, headaches did not correlate with cognitive test performance.

KEYWORDS:

• Traumatic brain injury
• cognition
• headache disorders

Acknowledgments

The authors thank the members of the “NEURO-detect” study team: Zeanna Jadavji, BSc, Trevor Low BSc, Shane Virani MSc, Helen Carlson PhD, Karen Barlow MB ChB MRCPCH [UK] MSc, Michael Esser MD PhD, Kathryn Schneider PhD PT, Catherine Lebel PhD, Signe Bray PhD, Frank MacMaster PhD, Marc Lebel PhD, and Ashley Harris PhD. Thanks to Lonna Mitchell BA and Kalina Slepicka BA for scoring protocols and (alphabetically) Amy Bobyn, Dominique Bonneville BA (Hons), Shauna Bulman, Christianne Laliberté-Durish MSc, Shelby MacPhail, Maya Sohn, and Cole Sugden for assistance with data entry/checking. Thanks to Brenda Turley BA (Hons), Carolyn Emery PhD PT, and Kathryn Schneider PhD PT for assisting with recruitment. Recruitment of some orthopedic control participants was done using the Healthy Infants and Children Clinical Research Program database (HICCUP; http://www.ucalgary.ca/paediatrics_hiccup). Thank you to the families who participated in this study and generously donated their time to research.

Conflict of interest

BB has previously received in-kind support (free test credits) from the publisher of the computerized cognitive test (CNS Vital Signs, Chapel Hill, North Carolina) used in this study. BB also receives royalties from the sales of other neuropsychological measures [Child and Adolescent Memory Profile (ChAMP, Sherman and Brooks, 2015, PAR Inc.), Memory Validity Profile (MVP, Sherman and Brooks, 2015, PAR Inc.), and Multidimensional Everyday Memory Ratings for Youth (MEMRY, Sherman and Brooks, 2017, PAR Inc.)], although these were not used in this study. None of the authors have a financial interest in any measures used in the present study.

Additional information

Funding

This study was funded by the Shaikh Family Research Award, an endowment held by the Alberta Children’s Hospital Foundation and granted to BB by the Alberta Children’s Hospital Research Institute. Additional support for the study was provided from the Ronald and Irene Ward Chair in Pediatric Brain Injury (awarded to KY). VK acknowledges studentship funding from the Alberta Children’s Hospital Research Institute (University of Calgary) and the Integrated Concussion Research Program (University of Calgary). VP acknowledges fellowship funding from the Alberta Children’s Hospital Research Institute (University of Calgary), the Integrated Concussion Research Program (University of Calgary), and Alberta Innovates-Health Solutions. MN is supported by the Vi Riddell Pain Initiative of the Alberta Children’s Hospital Research Institute. BB acknowledges salary funding from the Canadian Institutes for Health Research (CIHR) Embedded Clinician Researcher Salary Award.