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Pediatrics. 2015 Mar;135(3):504-12. doi: 10.1542/peds.2014-2695. Epub 2015 Feb 2.

Headache in traumatic brain injuries from blunt head trauma.

Author information

1
Division of Pediatric Emergency Medicine, Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, New York, New York; psd6@columbia.edu.
2
Departments of Emergency Medicine, and.
3
Division of Emergency Medicine, Helen DeVos Children's Hospital, Grand Rapids, Michigan; Department of Emergency Medicine, Michigan State University, East Lansing, Michigan; Departments of Emergency Medicine, and Pediatrics, School of Medicine, Western Michigan University, Kalamazoo, Michigan;
4
Departments of Pediatrics, and Emergency Medicine, Children's National Medical Center, School of Medicine, George Washington University, Washington, District of Columbia;
5
Departments of Pediatrics, and Emergency Medicine, School of Medicine, New York University, New York, New York;
6
Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, Maryland; and.
7
Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah.
8
Departments of Emergency Medicine, and Pediatrics, University of California Davis School of Medicine, Sacramento, California;

Abstract

OBJECTIVE:

To determine the risk of traumatic brain injuries (TBIs) in children with headaches after minor blunt head trauma, particularly when the headaches occur without other findings suggestive of TBIs (ie, isolated headaches).

METHODS:

This was a secondary analysis of a prospective observational study of children 2 to 18 years with minor blunt head trauma (ie, Glasgow Coma Scale scores of 14-15). Clinicians assessed the history and characteristics of headaches at the time of initial evaluation, and documented findings onto case report forms. Our outcome measures were (1) clinically important TBI (ciTBI) and (2) TBI visible on computed tomography (CT).

RESULTS:

Of 27 495 eligible patients, 12 675 (46.1%) had headaches. Of the 12 567 patients who had complete data, 2462 (19.6%) had isolated headaches. ciTBIs occurred in 0 of 2462 patients (0%; 95% confidence interval [CI]: 0%-0.1%) in the isolated headache group versus 162 of 10 105 patients (1.6%; 95% CI: 1.4%-1.9%) in the nonisolated headache group (risk difference, 1.6%; 95% CI: 1.3%-1.9%). TBIs on CT occurred in 3 of 456 patients (0.7%; 95% CI: 0.1%-1.9%) in the isolated headache group versus 271 of 6089 patients (4.5%; 95% CI: 3.9%-5.0%) in the nonisolated headache group (risk difference, 3.8%; 95% CI: 2.3%-4.5%). We found no significant independent associations between the risk of ciTBI or TBI on CT with either headache severity or location.

CONCLUSIONS:

ciTBIs are rare and TBIs on CT are very uncommon in children with minor blunt head trauma when headaches are their only sign or symptom.

KEYWORDS:

blunt head trauma; headache; traumatic brain injury

PMID:
25647678
DOI:
10.1542/peds.2014-2695
[Indexed for MEDLINE]
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