Friday, February 6, 2015

Headaches after Minor Blunt Head Trauma: Cause for Alarm or a Reassuring Symptom?

     Recognizing the earliest signs of a traumatic brain injury can be life-saving but what if that sign is a headache and the injury to the head is a mild one? Should these children get further investigated with neuroimaging or can we be reassured if headache is the only symptom present?
     Dayan et al. ( (doi:10.1542/peds.2014-2695)) investigated this concern by looking prospectively at a cohort of more than 12,000 children between the ages of 2 to 18 years who experienced minor blunt head trauma as characterized by a Glasgow Coma Score of 14 or 15.  The investigators then recorded whether headache was present and whether injury was noted on CT scan as well as whether it was a clinically-important traumatic brain injury.       
     Almost 20% of this cohort had isolated headaches with less than 1% showing a CT finding and none having a clinically significant traumatic brain injury.  Is this study enough to convince you to not image a child who has had a mild injury and headache only—or will you still want to get that head scan?  We think this study may result in less scans ordered—but would love to hear your take as well.  Share your comments via a response to this blog or via an e-letter or post on our Facebook and Twitter sites. 
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