To characterize pediatric neurologists’ prescribing habits for preventive treatment of post-traumatic headache (PTH) in children.

PTH is common after concussion, however there are no evidence-based treatments. Experts have recommended treating PTH like the primary headache disorder it most resembles, though this approach has limitations.

A single-center retrospective chart review included youth aged 8 - 17 years old with PTH who were seen in general neurology or headache clinics within 120 days of their concussion. Demographics, days post-injury, headache features, and past medical history were captured, as was treatment with a nutraceutical (NC) or prescription preventive medication (PM). Data were analyzed using univariate binomial regression analyses and descriptive methods.

Of 142 participants, 43% were recommended a NC, 27% got a PM, 5.6% got both, and 30% were not recommended a preventive. 80% had migraine-like headaches. Participants who received any preventive were more likely to be further out from their concussion (OR 1.01, p=0.023), have greater headache-related disability (OR 1.48 for each increase in disability grade, p=0.009), more frequent bad headache days (OR 1.36 for every increased frequency category, p=0.002), or have a continuous headache (OR 2.97 versus intermittent, p=0.003). Of PM recipients, 23/39 got amitriptyline, and 9/39 received topiramate. NC recipients got magnesium (50/61), riboflavin (34/61), or melatonin (12/61), often in combination (34/61). Sensitivity analysis of NC vs. PM revealed those who were older, had a higher headache burden, and had medication overuse were more likely to receive a PM. Of those with high headache frequency and headache-related disability, 68.5% were offered a preventive, but 31.5% were not.

Increased headache burden and symptom duration predicted recommendation of a preventive medication, mirroring standard care for migraine prevention, though there is room for practice improvement. Amitriptyline was the most utilized PM, and represents the most studied medication for PTH in children.