Use of Ibuprofen and Acetaminophen for Treatment of Acute Headache Post Concussion in Children
Use of Ibuprofen and Acetaminophen for Treatment of Acute Headache Post Concussion in Children
Concussions and headache are a significant problem for children and athletes. While headache
 generally resolves within 7-10 days; a significant proportion of children, 72-93% experience
 prolonged headache as a symptom of Post Concussion Syndrome (PCS). The prevailing clinical
 view is that mild head injuries resolve with little chance of complications. However, the
 reality is quite different. Concussion in children presents with a range of severity and
 results in both short and long-term physical, cognitive, emotional and behavioural sequelae
 known as PCS with varying times to resolution. To date there are no specific treatments for
 headache pain related to concussion. Physical and cognitive rest is the mainstay of initial
 concussion management.

 The number of children presenting to ED's with a history of concussion and headache is
 increasing. Presently there are no evidence based guidelines available to guide the medical
 team to effectively and consistently manage their headache. Our present standard of care is
 based on the CANCHILD concussion guidelines outlining the child's return to school and
 activity. Yet, our present standard of treatment is compromised and somewhat
 counterproductive if we are not treating the child's headache pain.

 Our pilot study ' An Open Label Randomized Control Pilot Study Examining Treatment of
 Headache In The Post-Concussive Youth' showed that routine administration of oral analgesia
 improves the child's headache symptoms and helps with school re-entry one week post injury,
 compared to a standard care group defined as non routine administration of pain medications.
Objective Post Injury concussion and headache are problematic for children after mild
 traumatic brain injuries. There are no evidence based guidelines for the management of acute
 post concussive headache. The objectives of this study were to assess the efficacy of routine
 administration of analgesia on concussion headache and classify headaches using the IHS
 criteria.

 Method A 4 arm open label pilot RCT study was conducted. The treatment arms were: (i)
 acetaminophen,(ii) ibuprofen, (iii) acetaminophen and ibuprofen and (iv) a standard control
 group. Eight to eighteen year olds presenting to emergency with headache 24-48 hours after
 their first concussion were recruited consecutively and sequentially randomized. Demographic
 data was collected, headache survey administered and standard concussion education given.
 Headaches were diarized over one week capturing the (i) number of headaches, (ii) headache
 days,(iii) headache intensity and (iv) return to school.
Inclusion Criteria:

 -  diagnosed with a first time concussion

 -  english speaking

 -  presenting to Emergency with headache 24-48 hours post concussion

 -  normal Glascow Coma Scale

 -  8-18 years of age

 Exclusion Criteria

 -  postive findings on CT scan

 -  patient with cervical injury

 -  history of multiple concussions

 -  positive neurology