Use of Ibuprofen and Acetaminophen for Treatment of Acute Headache Post Concussion in Children
Condition: Concussion; Headache
MeSH terms: Headache
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): Acetaminophen; Ibuprofen
Intervention type(s): Drug; Drug
Intervention description(s): routine administration of medication for a 72 hour period; routine administration of medication for a 72 hour period
Other intervention name(s): tylenol; advil
Intervention MeSH terms: Acetaminophen; Ibuprofen
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)