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Kristen Lambrinakos-Raymond, Brett Burstein, Isabelle Gagnon, Roger Zemek, Alexander Sasha Dubrovsky, 77 MANAGEMENT OF PEDIATRIC POST-CONCUSSIVE HEADACHES: A NATIONAL SURVEY OF ABORTIVE THERAPIES USED IN THE EMERGENCY DEPARTMENT, Paediatrics & Child Health, Volume 25, Issue Supplement_2, August 2020, Page e32, https://doi.org/10.1093/pch/pxaa068.076
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Abstract
The incidence of children presenting to an Emergency Department (ED) following concussion has increased markedly in recent decades. Headache is the most commonly associated symptom and recent guidelines emphasize the importance of analgesia, yet evidence to inform treatment of post-concussive headache (PCH) is completely lacking.
This study sought to characterize abortive therapies used to treat PCH among physicians in academic pediatric EDs and to determine whether duration of symptoms and/or headache intensity influence treatment strategies.
A scenario-based electronic survey was sent to physician members of the Pediatric Emergency Research Canada (PERC) database. Participants were asked questions regarding management when presented with cases of an adolescent presenting to the ED with PCH refractory to appropriate doses of acetaminophen and ibuprofen. Scenarios differed only by duration of symptoms (48-hours versus 1-month post-injury), as well as headache intensity (moderate versus severe). Descriptive statistics are reported.
Survey response rate was 63% (n/N=137/219). At 48 hours post-injury, 93% of physicians reported that they would initiate treatment for a headache rated as severe. The most commonly selected medications to treat PCH were metoclopramide (72%), an intravenous bolus of normal saline (47%) and non-steroidal anti-inflammatories (NSAIDS; 35%). There was wide variability among second line strategies for refractory pain following first-line treatment. When presented with PTH pain rated moderate in severity, 63% of respondents would change their management compared to severe pain, with 66% no longer offering pharmacologic treatment in the ED and most frequently selecting oral NSAIDS (58%) when electing to initiate treatment. Medication selection was unchanged when presented with a patient reporting severe PCH at 1 month compared to 48-hours post-injury.
Most physicians would treat pediatric PCH in the ED for a patient reporting severe pain, however, pain rated as moderate was less likely to receive abortive treatment. Metoclopramide was the most frequently selected medication for analgesia for severe pain. Future research should aim to establish the efficacy of this and comparative treatments for PTH in children.
