Acute and chronic management of posttraumatic headache in children: A systematic review.
Acute and chronic management of posttraumatic headache in children: A systematic review.
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作者：
Patterson Gentile C;Shah R;Irwin SL;Greene K;Szperka CL
本文的目的是提供一个汇编的证据，为治疗创伤后头痛（PTH）的儿科人口。头痛的特点和治疗的时机进行了考虑。头痛是轻度创伤性脑损伤（mTBI）后最常见的症状，影响超过80%的儿童和青少年。目前尚不清楚是否应根据头痛特征，特别是偏头痛特征的存在和/或头痛的慢性程度来定制PTH的治疗。对PubMed、Embase、Scopus和科克伦数据库（1985-2021年，仅限于英文）进行了系统性文献检索，并将纳入研究的关键特征输入RedCAP®（Prospero ID CRD 42020198703）。纳入了描述随机对照试验（RCT）、队列研究、回顾性分析和病例系列的文章和会议摘要。参与者包括18岁以下急性（<3个月）和持续（≥3个月）PTH的青年。纳入了评论治疗后头痛改善的研究。27项独特研究符合入选标准，描述了流产药物治疗（9）、预防性药物治疗（5）、神经调节（1）、手术（5）、物理治疗和运动（6）以及行为治疗（2）。确定了5项RCT。专注于流产药物治疗的研究在mTBI后的前2周内完成，而其他治疗方式则专注于损伤后1个月至1年以上的结果。很少有研究报道偏头痛的特征（7），偏头痛的个人史（7）或偏头痛的家族史（3）。关于治疗儿童人群PTH的有效治疗时机和类型的证据有限。需要进行前瞻性研究，解释头痛的特征，并考虑治疗的时机和结果的测量。
The goal of this paper is to provide a compilation of the evidence for the treatment of posttraumatic headache (PTH) in the pediatric population. Headache features and timing of therapy were considered. Headache is the most common symptom following mild traumatic brain injury (mTBI), affecting more than 80% of children and adolescents. It is unclear whether treatment for PTH should be tailored based on headache characteristics, particularly the presence of migraine features, and/or chronicity of the headache. Systematic literature searches of PubMed, Embase, Scopus, and Cochrane databases (1985–2021, limited to English) were performed, and key characteristics of included studies were entered into RedCAP® (Prospero ID CRD42020198703). Articles and conference abstracts that described randomized controlled trials (RCTs), cohort studies, retrospective analyses, and case series were included. Participants included youth under 18 years of age with acute (<3 months) and persistent (≥3 months) PTH. Studies that commented on headache improvement in response to therapy were included. Twenty-seven unique studies met criteria for inclusion describing abortive pharmacologic therapies (9), preventative pharmacotherapies (5), neuromodulation (1), procedures (5), physical therapy and exercise (6), and behavioral therapy (2). Five RCTs were identified. Studies that focused on abortive pharmacotherapies were completed in the first 2 weeks post-mTBI, whereas other treatment modalities focused on outcomes 1 month to over 1-year post-injury. Few studies reported on migrainous features (7), personal history of migraine (7), or family history of migraine (3). There is limited evidence on the timing and types of therapies that are effective for treating PTH in the pediatric population. Prospective studies that account for headache characteristics and thoughtfully address the timing of therapies and outcome measurement are needed.
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