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doctor showing girl with concussion three fingers

Post-traumatic headache phenotype and recovery time after concussion

doctor showing girl with concussion three fingers

In a recent study published by JAMA Network Open, Gerard Gioia, Ph.D., division chief of Neuropsychology and director of Safe Concussion Outcome, Recovery and Education (SCORE) Program at Children’s National Hospital, along with other leading researchers, described the characteristics of youth with post-traumatic headache (PTH) and determine whether the PTH phenotype is associated with outcome.

Concussions and mild traumatic brain injuries (mTBI) are common among children and adolescents and constitute a major public health challenge. While symptoms from a concussion typically resolve days to weeks after injury, 10% to 30% of patients have symptoms that last longer than four weeks, and a smaller proportion have symptoms that persist for much longer.

PTH is defined as significantly worsened head pain attributed to a blow or force to the head. Although adolescents have a higher risk for sustaining concussions and developing persistent symptoms than younger children or adults, there is little data regarding PTH recovery and treatment in youth.

Dr. Gioia founded the multicenter Four Corners Youth Consortium to fill the gap in our understanding of youth concussion and recovery. This study is the first analysis of PTH phenotype and prognosis in this cohort of concussed youth.

The researchers analyzed headache-related symptoms from a validated questionnaire developed by Dr. Gioia and his Children’s National concussion research team. The primary outcomes were time to recovery and concussion-attributable headache three months after injury while the secondary outcome was headache six months after injury. Recovery was defined as resolution of symptoms related to a concussion.

Future large studies validating the classification of posttraumatic headache phenotypes in youth and studying outcomes are essential. PTH phenotyping will improve prognostication of concussion recovery and will enhance the treatment for PTH with more appropriate and targeted therapies to treat and prevent persistent and disabling headaches in youth with a concussion.

Teenage boy sleeping

Longer concussion recovery in children connected to poor sleep

Teenage boy sleeping

A new research study suggests that adolescents who get a good night’s sleep after a sports-related concussion might be linked to a shorter recovery time.

Research presented at the American Academy of Pediatrics Conference in Orlando, Fla., concluded that young athletes who slept well after a concussion were more likely to recover within two weeks, while those that didn’t receive a good night’s rest increased their likelihood to endure symptoms for 30 days or more.

The design and method was observational, where sleep factors and recovery are examined in association with each other. While the design does not allow a strong causal relationship to be established, it does not report control of other possible mediating variables, its sample size and strength of the findings are strongly suggestive, and provide a rationale for further study of sleep as a critical factor in recovery.

According to Gerard Gioia, Ph.D., chief of the Division of Pediatric Neuropsychology at Children’s National Health System, clinicians should ensure that sleep is properly assessed post-concussion and appropriate sleep hygiene strategies should be provided to the patient and family.

The average age of the 356 participants in the study was 14. Researchers conducting the study had the participants complete a questionnaire called the Pittsburgh Sleep Quality Index. Based on the answers reported, the teens were grouped into two categories: 261 good sleepers and 95 poor sleepers.

“The study highlights the importance of sleep, a critical factor in the recovery from a concussion,” says Dr. Gioia, “These findings are highly consistent with our own clinical experience in treating children and adolescents with concussions in that poor sleep are a significant limiting factor in recovery.”

During the follow-up visits three months later, both groups of patients had improved, however the good sleepers continued to have significantly better symptoms and sleep scores.