Abstract Details

Title Post Traumatic Headache Worsened by Subgaleal Hematoma Secondary to Tight Braids in an Adolescent Male

Topic Headache

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 15-018

Objective NA

Background Subgaleal hematoma (SGH) is a fluid collection caused by rupture of the emissary veins traversing the subaponeurotic space. Mostly seen in the neonatal period, it is rarely seen in older children and typically occurs secondary to scalp traction or injury, with symptoms including scalp tenderness or headaches. We report a unique case of post-traumatic headaches (PTH) exacerbated by subgaleal hematomas related to hair braiding.

Design/Methods A 14-year-old boy presented 7 weeks post-injury after a trampoline fall with head impact and transient loss of consciousness. He was evaluated emergently following his head injury and diagnosed with concussion. He had improvement of symptoms though 3 days afterwards, experienced holocephalic migraine-like headaches that were responsive to acetaminophen or ice packs, but still persistent. Examination noted mild cervicalgia with lateral rotation and provocation of headaches on vestibular-ocular-motor screening (VOMS) without focal neurological deficits. He was prescribed amitriptyline for treatment of post-traumatic headaches. Given persistence of symptoms, a brain MRI was ordered to rule out an intracranial process.

Results MRI of the brain showed no intracranial pathology; rather, incidentally revealed multiple subgaleal scalp fluid collections oriented linearly along the spaces between the patient’s hair braids. He was advised to loosen the hair braids and reported a notable improvement in headache frequency and severity after intervention, which gradually resolved over the following weeks.

Conclusions Post-traumatic headaches are a common sequela following head or neck trauma, and often self-resolving. Subgaleal hematoma can be a rare complication of tight hairstyles. In our case, the SGH likely contributed to a protracted course and complicated the headache presentation. Although our patient had evidence of vestibular ocular dysfunction following concussion, it can also be seen in headache disorders, highlighting the importance of investigating potential secondary etiologies if persistent headaches or change of character is present despite appropriate interventions.

Authors/Disclosures
Michael S. Kung, MD PRESENTER	Dr. Kung has nothing to disclose.
Mathew Stokes, MD (University of Texas SW Medical School, Child Neurology)	The institution of Dr. Stokes has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Global Medical Response.
Eric M. Remster, MD (UT Southwestern Medical Center)	Dr. Remster has nothing to disclose.
Ishani Kumar, MD	Dr. Kumar has nothing to disclose.

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