Chronic Headache after Pediatric Brain Injury: A Systematic Review

Introduction: Chronic pain is an under-diagnosed consequence of traumatic brain injury (TBI) in subjects aged ≤16. The objective of this study was to determine its prevalence. Methods: The Ovid/Medline database was searched for articles published between 1951 and February 2008 using any combination of the terms brain injury, pain, headache, blast injury, and combat. The PubMed, MD Consult, Cochrane Collaboration, National Institutes of Health Clinical Trials Database, Meta-Register of Current Controlled Trials, and CRISP databases were searched using the keyword brain injury. 1110 articles were identified for evaluation. 258 articles were reviewed and 26 met the inclusion criteria for calculating the prevalence of chronic pain after TBI. Three cross-sectional studies met the inclusion criteria for calculating this prevalence in the population aged ≤16. Results: Twenty-six studies (18 cross-sectional, 5 prospective, and 3 retrospective) including 4468 patients with TBIs were identified. Fifteen studies assessed headache (HA) pain in 1932 patients. Of these, 1081 complained of chronic HA, yielding a prevalence of 56.0% (95% CI, 53.9% 58.2%). Three studies furnished data on 262 patients with TBI and age ≤16. One-hundred-fifteen of these subjects experienced chronic HA suggesting prevalence of 43.9% (95% CI, 37.9% 49.9%) in this population. We found evidence to suggest that there is an association between TBI and the development of chronic HA pain. Conclusions: Chronic pain from headache is a common complication of TBI and is common even among children with apparently minor injuries to the brain. The evidence suggests that this condition is independent of psychiatric disorders such as post-traumatic stress disorder and depression.