kids ’ korner By A . David Rothner , MD
Post-Concussion Headache in Sports
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FOR HALEY MANKIN of Newtown Square , Penn ., cheerleading was life . She had migraine and New Daily Persistent Headache that appeared at age 13 , but that didn ’ t stop her from participating in activities and going to school . That is , until a cheerleading competition at age 15 . Mankin was at the bottom of a human pyramid when it collapsed ; she was hit in the head three times , resulting in a concussion . She doesn ’ t remember the moments that followed , although her friends tell her she seemed confused .
“ We weren ’ t that panicked ,” says her mother , Lisa Goldstein , MD , a child psychiatrist . “ We ’ d seen other kids with concussions . We thought she ’ d be back to her normal self quickly . It wasn ’ t until we started to realize she wasn ’ t recovering like other kids that the gravity of the situation began to set in .”
Six weeks after the concussion , Haley ’ s migraines increased from her usual two times a month to three times a week . Ten weeks after the trauma , she was hospitalized for nine days with intractable daily migraine and vomiting . Now 17 , Haley continues to experience daily headaches and has been diagnosed with post-concussion headache in the form of chronic migraine . She is home-schooled and typically unable to complete more than three non-consecutive hours of schoolwork a day or go to noisy or busy places like the grocery store , movie theater or mall .
Up to 3.8 million recreation- and sport-related concussions occur annually in the United States , according to the Centers for Disease Control and Prevention . Elementary and middle school concussions are less researched and receive less publicity because younger children do not play as many organized sports , do not hit as hard and weigh less . By high school , concussions represent an estimated 8.9 percent of all athletic injuries , according to research published in the Sept . 2010 issue of the journal Pediatrics . Some would suggest girls have a higher rate of concussion , with researchers suggesting a smaller head mass in females may be to blame . However , boys tend to have a higher number of concussions , due to participation in more sports and in contact sports ( namely , football ).
To avoid post-concussion headaches , concussion prevention in children ’ s sports is essential ; that includes teaching children how to tackle properly and having the right protective gear . Those who experience post-concussion headaches must seek treatment early to attempt to return to function and a full life .
LINGERING HEADACHES AFTER TRAUMA
Sport-related concussion is an alteration in the functioning of the brain caused by a blow to the athlete ’ s head ( or body with force transmitted to the head ). In most cases , symptoms resolve in seven to 10 days , according to the journal Pediatrics . But sometimes headaches , the most common symptom of concussion , could linger for months .
Post-concussion headache ( PCH ), a type of posttraumatic headache , is a secondary headache that develops as the result of a concussion . The headaches can present in many forms : tension-type headache , episodic migraine , chronic daily headache or a combination . Those who already had headaches or a family history of headaches prior to the trauma are more likely to experience some form of PCH , and PCH is thought to be more severe in girls with a history of headache . According to the International Classification of Headache Disorders , post-traumatic headaches develop within seven days of the traumatic event . However , most headache specialists agree that if headaches start even within several weeks of the concussion , those headaches can still be considered post-traumatic headaches .
Once diagnosed — generally via a thorough history ( including a review of symptoms ) followed by a neurological exam — a treatment path is designed based on the specific type of headache that the child is experiencing .
BOUNCING BACK , SLOWLY
Successful treatment isn ’ t easy for many PCH sufferers . Excessive use of over-the-counter medications ( defined as use more than twice a week ), excessive school absences and pain can make it more difficult for children and their parents to reach out to a physician . Yet such complications also point to a need for children with PCH to find treatment .
To improve PCH , headache specialists advise adequate sleep , adequate hydration , educational support and counseling . Exercise is recommended , though physicians will generally advise exercise that starts slowly , increasing over time .
It may also be important to adjust to a new lifestyle , modifying schooling and activities that can exacerbate
Tips for Parents and Children
Dr . Goldstein and her daughter , Haley , offer these tips for children and parents of children who are involved in sports :
TAKE RESPONSIBILITY FOR EDUCATION . Make sure you , your coaches and your school administrators understand the risks for concussion , recurrent concussions , return-to-play guidelines , and evaluation and treatment options .
BE AWARE OF PREDISPOSING FACTORS . Adolescents who have a previous history of headache or a strong family history of headache seem to have more problems with headaches after concussion .
BE OPEN WITH EACH OTHER AND TAKE ACTION . Haley admits that the concussion from the pyramid was likely not the first concussion she ’ d had . She had been hit in the head in cheerleading before but says , “ I wasn ’ t telling anyone because I didn ’ t want my mom to worry or make me quit cheerleading .” It ’ s important for children to be honest because they symptoms can worsen if there are recurrent concussions .
STAY OPTIMISTIC . “ Know that it will get better eventually ,” Haley says . “ Until then , try to find things that make you happy and find ways to enjoy the life you have .” Haley learned to play guitar , listens to audiobooks and watches the show Glee , which she says has helped her through the hardest days .
symptoms . With that in mind , it would be prudent to enlist the help of an educational counselor who can modify the child ’ s schedule and an emotional counselor who can help them work through their feelings about their pain and adjusted lifestyle .
Eventually , treatment should help PCH to resolve on its own , although that resolution may occur at a different point in time for every patient . The majority of individuals with PCH improve within a couple of weeks of the trauma . Haley Mankin represents a smaller proportion of adolescents whose PCH persists . For patients with persistent PCH , it is even more important to see an expert and follow a treatment plan .
“ There ’ s always a balance between looking for the next treatment , cure or doctor , versus accepting that for right now this is how she is going to be ,” Dr . Goldstein says , of Haley . “ But I never give up hope that she ’ ll get better .” Hw
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