First author (date) |
Study type |
Participant characteristics |
Treatment |
Outcome |
Data quality |
Abortive pharmacotherapies (oral) |
Petrelli et al. (2017)17 |
Prospective randomized open-label control trial |
Participants presented to the emergency department within 48 h of mTBI |
Migrainous headache: 39% |
Treatment with the following analgesic regimens for 1 week: 1. Ibuprofen 10 mg/kg q8 h ×72 h (n = 20) 2. Acetaminophen 10–15 mg/kg q4 h ×72 h (n = 20) 3. Alternating acetaminophen and ibuprofen ×72 h (n = 19) 4. Standard of care: no analgesic recommendations (n = 20) |
Outcome measures: Number of headache days, number of headache episodes, headache intensity, and higher return to school rate over 1 week of treatment |
Fair |
Age range (mean): 8–18 years (12.9) |
Hx of migraine: NR |
Outcome: • Patients in any of the treatment arms had fewer headache days, headache episodes, and lower headache intensity, and a greater percentage were back to school compared to the standard of care group. • Subjects in the alternating group had the best response • Ibuprofen.: #headache days 5/7, back to school 61% • Acetaminophen: #headache days 7/7, back to school 33% • Both: #headache days 4/7, back to school 79% • Standard of care: #headache days 7/7, back to school 21% • Mean (SD) headache episodes/patient/day and headache intensity for each of the 7 days in the trial were reported |
FamHx of migraine: NR |
n = 79 (50% female) |
**Included 18 years old |
Heyer et al. (2014)22 |
Retrospective cohort |
Participants meeting criteria for medication overuse headache (MOH) who presented to a headache clinic >3 months following mTBI |
Migrainous headache: NR |
Discontinuation of as-needed analgesics (ibuprofen, acetaminophen, naproxen, oxaprozin) |
Outcome measure: Headache improvement or resolution within 2 months of discontinuing analgesics |
Poor |
Age range (median): 13–17 years |
Hx of migraine: 37% |
Outcome: • 68.5% of subjects with MOH reported headache improvement after discontinuing analgesics. No further statistical analysis was reported |
(15.2) |
FamHx of migraine: NR |
n = 77 (63% female; 54/77 met criteria for MOH) |
Note: 75.9% of participants with MOH had daily episodic or continuous headache |
Cohen and Conidi (2015)20 (abstract) |
Retrospective cohort |
Participants were diagnosed with concussion/mTBI at a tertiary care center. Age range: 14–19 years n = 19 (randomly selected) |
Migrainous headache: NR |
Any reported therapies for PTH |
Outcome measure: Headache relief |
Poor |
**Included ≥18 years old |
Hx of migraine: NR |
Outcome: • Triptans and onabotulinumtoxinA reported as providing the most rapid headache relief. No statistical analysis was provided |
FamHx of migraine: NR |
Tejani et al. (2017, 2019)18, 19 (abstract) |
Prospective cohort |
Participants presented to a concussion clinic within 30 days of concussion/mTBI |
Migrainous headache: NR |
Effect of NSAID and triptan use within 30 days of concussion/mTBI 1. NSAIDs only (61% of participants) 2. Triptans only (1.1% of participants) 3. NSAIDs + triptans (5.3% of participants) 4. No treatment (32.6% if participants) |
Outcome measure: Headache resolution, and headache severity at 3 months |
Poor |
Age range: 6–18 years n = 528 (45% female) |
Hx of migraine: NR |
Outcome: • Reduction in number of subjects reporting headache from 75.4% to 18% regardless of treatment group with no significant difference between the NSAID group and no treatment group (81.4% → 18.6% vs. 86.6% → 13.4%, p = 0.165) • A higher proportion of subjects who used triptans reported greater headache severity compared to the NSAIDs group (5/5 triptans group vs. 10/28 NSAIDs + triptans group vs. 23/172 NSAID group, p < 0.001) • Subjects who used triptans reported greater headache severity than those who used NSAIDs (mean triptan only 1.6 95% CI: 1.0–2.4, mean triptan+NSAID 1.0 95% CI: 0.7–1.4, mean NSAID only 0.3 95% CI: 0.2–0.4, mean no med 0.2 95% CI: 0.1–0.3) |
**Included 18 years old |
FamHx of migraine: NR |
Bramley et al. (2012)21 |
Retrospective case series |
Case series included a 10-year-old male and a 15-year-old female presenting with concussion/mTBI within the first month |
Migrainous headache: 100% |
4 mg 6-day tapering Medrol dose pack in addition to other abortive and preventative therapies. Other medications included amitriptyline, melatonin, and gabapentin |
Outcome measure: Descriptive, headache improvement |
Poor |
Hx of migraine: NR |
Outcome: • Both subjects reported improvement with Medrol dose pack • One subject completed an additional 14-day taper because of symptom return following completion of the first taper. No significance testing was reported |
FamHx of migraine: NR |
Abortive pharmacotherapies (intravenous) |
Lumba-Brown et al. (2014)23 |
Prospective randomized controlled trial |
Participants were recruited acutely following concussion/mTBI in an emergency department (duration post-injury not specifically reported) |
Migrainous headache: NR |
Participants were randomized to receive a single dose of 10 ml/kg of one of the following given over 1 h: 1. 3% hypertonic saline (HTS, 52% of participants) 2. Normal saline (NS, 48% of participants) |
Outcome measure: Wong-Baker face scale pain score before versus immediately after infusion, and 2–3 days later |
Fair |
Age range (mean): 7–16 years |
Hx of migraine: NR |
Outcome: • Participants who received HTS reported a greater reduction in pain scores compared to NS immediately (3.52 vs. 1.14-point decrease, mean difference between groups −2.38 95% CI: −0.3 to −1.4*, p < 0.001) and 2–3 days after infusion (4.61 vs. NS 3.00-point decrease, mean difference between groups −1.61 95% CI: −2.90 to −0.30, p = 0.014) • A multiple-regression model used to adjust for initial higher pain reports in the HTS group and other potential confounders still demonstrated a significantly greater reduction in pain in the HTS compared to NS group (mean difference between groups −1.86 95% CI: 0.92 to 2.79*)*95% CI intervals may contain an error, and sign conventions may also be reported in error |
(12) |
FamHx of migraine: NR |
n = 44 (37% female) |
Bresee et al. (2018)24 |
Prospective cohort, planned subanalysis |
Participants presented to the emergency department within 48 h of concussion/mTBI |
Migrainous headache: NR |
Participants received one of the following: 1. Single dose of IV metoclopramide (dosage not reported, 3% of participants) 2. No treatment (97% of participants) |
Outcome measure: Persistent headache at 1 and 4 weeks |
Fair |
Age range: 8–17 years |
Hx of migraine: 13% |
Outcome: • IV metoclopramide was not associated with lower rate of persistent headaches at 1 week (unadjusted RR 1.0 95% CI: 0.8–1.3; adjusted multivariable logistic regression OR 0.6 95% CI: 0.4–1.1; adjustment with propensity score using 1:4 matching algorithm RR 0.8 95% CI: 0.6–1.2) • At 4 weeks (unadjusted RR 1.0 95% CI: 0.9–1.2; adjusted multivariable logistic regression OR 0.8 95% CI: 0.4–1.5; adjustment with propensity score using 1:4 matching algorithm RR 0.9 95% CI 0.8–1.1) |
n = 2095 (41% female) |
FamHx of migraine: 47% |
Note: 75% reported constant headache |
Chan et al. (2015)25 |
Retrospective cross-sectional |
Participants presented to the emergency department within 14 days of concussion/mTBI (mean 2 days) and received IV headache treatment |
Migrainous headache: NR |
Participants received IV NS bolus and the following IV medications (dosages not reported): 1. Ketorolac only (21% of participants) 2. Prochlorperazine, metoclopramide, chlorpromazine (12% of participants) 3. Ondansetron only (15% of participants) 4. Ketorolac + metoclopramide or prochlorperazine (52% of participants)(4) |
Outcome measure: Treatment success defined as >50% reduction in headache severity score (0–10) after infusion. Headache resolution was also reported |
Poor |
Age range (mean): 8–21 years |
Hx of migraine: 21% |
Outcome: • 86% (95% CI: 82.0%–90.4%) had treatment success overall • 80% in the ketorolac only group • 93% in the metoclopramide or prochlorperazine only group • 89% in the combined group • 79% in the ondansetron only group • 52.4% (95% CI: 46.3–58.5) reported headache resolution overall • Patients who got a head CT were less likely to have treatment success (80% vs. 91%, p = 0.008) • Patients who did not get a head CT were significantly more likely to have treatment success (multivariable analysis OR 2.95, 95% CI: 1.39–6.56) |
(13.8) |
FamHx of migraine: NR |
n = 254 (51% female) |
**Included ≥18 years old |
Katz et al. (2018)26 (abstract) |
Retrospective cohort |
Participants presented with concussion/mTBI to an outpatient infusion center |
Migrainous headache: NR |
Participants received a single dose of IV ketorolac, prochlorperazine, diphenhydramine, and 20 ml/kg NS |
Outcome measure: Headache improvement, headache severity scale (0–6) at follow-up after the infusion |
Poor |
Age: ≤18 years |
Hx of migraine: NR |
IV fluid (medication dosages not reported) |
Outcome: • 23/27 (85%) reported headache improvement, 1/27 (4%) found no improvement, 3/27 (11%) were not asked • Mean headache score was reduced from a 4/6 to a 2/6. No significance testing was reported |
n = 27 |
FamHx of migraine: NR |
**Included 18 years old |
Preventative pharmacotherapies |
Kuczynski et al. (2013)47 |
Retrospective cohort |
Participants presented with concussion/mTBI to a concussion clinic a median of 6.9 months (range 1–29 months) post-injury |
Migrainous headache: 39% |
Participants were placed on the following medications for a mean duration of 5.5 weeks (SD 4.3 weeks): 1. Amitriptyline, up to maximum of 1 mg/kg/day based on response (n = 18, 41%) 2. Nortriptyline, dosage not given (n = 9, 20%) 3. Topiramate up to 1.5–2 mg/kg/day to a max 200 mg/day (n = 6, 14%) 4. Flunarizine, dosage not given (n = 8, 18%) 5. Melatonin, 3–10 mg nightly (n = 12, 23%) 6. Indomethacin, dosage not given (n = 2, 5%) 39% received more than one treatment |
Outcome measure: Significant response defined as ≥50% reduction in headache frequency. Headache resolution was also reported |
Poor |
Age range (mean): ≤18 years |
Hx of migraine: 14% |
Outcome: • 64% reported successful response to preventative migraine medications: • 13/18 (72%) on amitriptyline • 1/11 (11%) on nortriptyline • 0/6 (0%) on topiramate • 5/8 (63%) on flunarizine • 9/12 (75%) on melatonin • 2/2 (100%) on indomethacin (had stabbing headache) • 45% reported headache resolution • Length of time for follow-up was not a significant predictor of symptom resolution (χ 2 = 0.341, p = 0.559) |
(14.1) |
FamHx of migraine: 52% |
n = 44 (66% female) |
Note: 61% experienced daily headache at the start of treatment |
**Included 18 years old |
Bramley et al. (2015)28 |
Retrospective cohort |
Participants presented to a concussion clinic, "majority within 1–3 weeks of concussion" |
Migrainous headache: NR |
Amitriptyline started in those with persistent headache at 1 month postconcussion (n = 68; 17% of participants) at 10–100 mg/day (median 25 mg/day) for a median duration of 4 months (range 2–7 months) |
Outcome measure: Improvement in headache symptoms |
Poor |
Age range: 13–18 years |
Hx of migraine: NR |
Outcome: • 82% (95% CI 70%–91%) reported improvement in headache symptoms • 33% (95% CI 12%–38%) of those on amitriptyline reported side effects • Females were more likely to be prescribed amitriptyline (24% vs. 13%, p = 0.004) |
n = 400 (38% female) |
FamHx of migraine: NR |
**Included 18 years old |
Markus et al. (2016)46 |
Retrospective case–control study |
Participants with TBI (81% with concussion/mTBI) presented to a headache clinic a median of 12 months (range 2–120 months) after injury |
Migrainous headache: 54% |
20 participants were prescribed one of the following agents: 1. Amitriptyline (n = 11) 2. Propranolol (n = 6) 3. Topiramate (n = 3) (Dosages not reported) |
Outcome measure: Positive response was defined as ≥50% reduction in number of headache days |
Poor |
Age range (median): 2–17 years |
Hx of migraine: NR |
Outcome: • 10/20 (50%) of TBI participants prescribed preventative medication reported a positive response: • 36% improved on amitriptyline • 50% on propranolol • 100% on topiramate • No significance testing was reported |
(9) |
FamHx of migraine: NR |
n = 74 (43% female) |
Mackie and Kirkham (2017)29 (abstract) |
Retrospective cohort |
Participants presented with concussion/mTBI to a nurse-led neurology clinic |
Migrainous headache: 71% |
All participants received school accommodations/decreasing cognitive load. In addition, 16 participants (42%) were treated with topiramate (median dose 2 mg/kg/day) |
Outcome measure: Headache improvement, reported reduction in migraine frequency/migraine severity |
Poor |
Age range (median): 3–16 years |
Hx of migraine: NR |
Outcome: • 84% reported headache improvement from the whole cohort • 12/16 participants (75%) prescribed topiramate reported reduction in frequency and severity of migrainous headaches • No significance testing was reported |
(13.8) |
FamHx of migraine: NR |
n = 38 (45% female) |
Sabo et al. (2017, 2018)30, 31 |
Retrospective case series |
Case series of children and adolescents diagnosed with pseudotumor cerebri following mTBI |
Migrainous headache: NR |
Acetazolamide 750–1000 mg BID (not all dosing reported) for a treatment interval 6 weeks–4 months |
Outcome measure: Headache improvement |
Poor |
Age range: 5–16 years n = 6 (66% female) |
Hx of migraine: NR |
Topiramate (dosing not reported) |
Outcome: • 4/5 had improvement with acetazolamide, the nonresponder was found to have craniosynostosis • 1/1 had improvement with topiramate + acetazolamide • Two worsened on amitriptyline, and one worsened on propranolol, and one had only mild improvement on cyproheptadine prior to being diagnosed with pseudotumor cerebri • No significance testing was reported |
Case series of children and adolescents diagnosed with pseudotumor cerebri following mTBI |
FamHx of migraine: NR |
Neuromodulation |
Pinchuk et al. (2013)33 |
Retrospective cohort |
Participants with diagnosis of chronic PTH based on ICHD-2 criteria, 6–9 months following concussion/mTBI |
Migrainous headache: NR |
Transcranial direct current stimulation (tDCS) for 30–45 min per session with 60–90 μA intensity (number of sessions not reported) |
Outcome measure: Headache frequency (days/month), headache severity scale (0–10), % patients with ≥50% reduction in headache frequency, and % patients with headache resolution for ≥4.5 months post-tDCS |
Poor |
Age range (median): 11–16 years |
Hx of migraine: NR |
Outcome: • 52% reported headache resolution, with an additional 29% reporting ≥50% reduction in headache frequency • Headache severity significantly improved (mean 5.4 SD 1.8 → mean 1.9 SD 1.2; p < 0.001) • Headache frequency significantly improved (mean 10.3 SD 6.5 → mean 4.1 SD 2.2; p < 0.001) |
(13.6) |
FamHx of migraine: NR |
n = 44 |
Procedures |
Dubrovsky et al. (2014)34 |
Retrospective case series |
Participants with mean of 70 days post-injury with a diagnosis of acute or persistent PTH based on ICHD-3 |
Migrainous headache: 83% |
Greater occipital nerve block ±lesser occipital nerve block ± supraorbital nerve block with 2% lidocaine + epinephrine; participants received between 1 and 6 nerve blocks with median duration between repeated nerve blocks of 18.5 days. Many subjects received abortive therapies, preventative therapies, or both concomitant to their nerve block |
Outcome measure: Good therapeutic effect was defined as decrease in pain for >24 h or requested repeat nerve block, headache pain severity immediately after nerve block (0–10 scale) |
Poor |
Age range (mean): ≤18 years |
Hx of migraine: NR |
Outcome: • 93% reported good therapeutic effect, and 71% of nerve blocks resulted in 0/10 headache pain • Headache intensity decreased pre- versus post-headache (mean = 5.6, SD = 1.6 vs. mean = 0.4, SD = 0.9); % reduction mean = 93%, SD = 13% |
(14.6) |
FamHx of migraine: 77% |
n = 28 |
Note: history of headache was reported to be 70% |
**Included 18 years old |
Seeger et al. (2015)35 |
Retrospective case series |
Participants treated in concussion and TBI clinic who received a nerve block for PTH, mean of 5.6 months post injury (range 1–12 months) |
Migrainous headache: 40% |
Greater occipital nerve block with 2% lidocaine + steroid (triamcinolone or methylprednisolone). Study did not comment on concomitant use of other therapies |
Outcome measure: Full response was defined as >50% reduction in headache frequency, mean headache frequency (days/month) at follow-up was also reported. Routine follow up was via telephone 2–4 weeks after the procedure and 2–3 months for an in-person visit. Secondary outcomes included Rivermead Post-concussion Symptoms Questionnaire (RPSQ), and the Pediatric Quality of Life Inventory (PedsQL) |
Poor |
Age range (mean): 13–17 years |
Hx of migraine: 6% |
Outcome: • 64% of children had full response • Headache frequency decreased from mean 26 SD 7 days/month to mean 18 SD 12 days/month (p = 0.014) • RPSQ scores significantly decreased following treatment (mean 33.67 SD 13.47 vs. 24.33 SD 18.54; t(5) = 3.04, p = 0.029) • PedsQL improved post-treatment (mean 52.04 SD 21.36 vs. 68.75 SD 27.50; t(7) = −2.62, p = 0.035) |
(15.5) |
FamHx of migraine: NR |
n = 15 (14 presented for follow up), (67% female) |
Note: 13/15 (87%) had daily headaches at time of procedure |
6/15 (40%) met ICHD-3 criteria for occipital neuralgia |
Zaremski et al. (2015)36 |
Retrospective case series |
Participants (16, 17, and 28 years old) presented with symptoms of occipital neuralgia following concussion/mTBI |
Migrainous headache: NR |
Variable: Greater and lesser occipital nerve block, trigger point injections, cervical medial branch block of C2 to C3, third occipital nerve blocks |
Outcome measure: Headache improvement |
Poor |
**Included ≥18 years old |
Hx of migraine: NR |
Outcome: • Both participants under 18 years old experienced complete but temporary relief from nerve blocks. No significance testing was reported |
FamHx of migraine: NR |
Lin and Tung (2016)37 |
Retrospective case series |
Participants (8 yM, 15yF, and 18 yF) with PTH |
Migrainous headache: NR |
Acupuncture for 6 to >12 sessions initiated 4–6 weeks following concussion/mTBI for persistent headache |
Outcome measure: Headache frequency, headache severity (10-point scale) |
Poor |
**Included 18 years old |
Hx of migraine: NR |
Outcome: • All subjects reported reduction in headache frequency and a 3–7 point reduction in headache severity. No significance testing was reported |
FamHx of migraine: NR |
Physical therapy and exercise |
Schneider et al. (2014)38 |
Prospective randomized controlled trial |
Participants with persistent postconcussion symptoms a mean of 50 days (range 8–276) following concussion/mTBI |
Migrainous headache: NR |
Participants were randomized into the following groups: 1. Intervention group (n = 15): cervical spine and vestibular rehabilitation 2. Standard of care (n = 14) |
Outcome measure: Numeric pain rating scale for headache (010) compared between those who were cleared to return to sport vs. those who were not cleared in the treatment and control groups. Primary outcome measure was return to sport within 8 weeks of treatment |
Fair |
Age range (median): 12–30 years |
Hx of migraine: NR |
Both groups worked with a physiotherapist ×8 weeks or until medical clearance (mean number of sessions for each group = 6) |
Outcome: • There was no significant difference in reduction of headache severity between cleared and not cleared subjects in the treatment or the control groups. Change in severity score (post – pre-treatment): • Control group: Cleared: −7 (n = 1); Not cleared: −2.5 (range −7 to 1, n = 12a one participant in this group did not complete the follow-up questionnaire), p > 0.05 • Intervention group: Cleared: −3 (−8 to 0, n = 11); Not cleared: −2.5 (range −4 to 1, n = 4), p > 0.05 • Treatment group was 10.27 times more likely to be medically cleared to return to sport within 8 weeks (χ 2 = 13.08, p < 0.001) |
(15) |
FamHx of migraine: NR |
Both groups received postural education, range of motion exercises, cognitive and physical rest until asymptomatic followed by graded exertion |
n = 31 (42% female; 2 withdrew) |
**Included ≥18 years old |
Gauvin-Leplage et al. (2019)41 |
Retrospective analysis of a prospective cohort |
Participants reported ongoing symptoms at 4 weeks following concussion/mTBI |
Migrainous headache: NR |
Exercise based active rehabilitation intervention ×4 weeks |
Outcome measure: Post-concussion symptom scale (PCSS) headache symptom score (0–6) compared from baseline to 2 and 4-weeks f/u. Primary outcome was total PCSS score at these visits |
Fair |
Age range (mean): 8–17 years |
Hx of migraine: NR |
Outcome: • PCSS headache scores decreased over the 4 weeks of treatment. PCSS headache score: Girls 2.5 at baseline, 2.1 at 2-weeks f/u, 1.5 at 4-weeks f/u; Boys 1.9 at baseline, 1.3 at 2-weeks f/u, 1.1 at 4-weeks f/u; ANOVA, p < 0.001 for headache score change over time • More girls reported headache, and had higher PCSS toral scores at baseline, and experienced a faster recovery compared to boys. Repeated-measures ANOVA, sex-specific difference for headache (p = 0.046). Generalized mixed regression model total PCSS by gender: Boys visit OR (95% CI): Visit 1: −8.81 (−12.37 to −5.26); Visit 2: −7.37 (−9.6- to −5.14); Visit 3: −11.40 (−14.33 to −8.48) |
(14.3) |
FamHx of migraine: NR |
n = 355 (53% female) |
De Matteo et al. (2015)40 |
Prospective cross-sectional study |
Participants presented to a concussion clinic a median of 4.1 months (range 0.7–35) post-injury |
Migrainous headache: NR |
Exertional testing ×1 session |
Outcome measure: Reduction in headache symptom score (0–6) at 5-min, 30-min, and 24-h post-exertional testing, headache improvement. Primary outcome was total decrease in symptom scores |
Poor |
Age range (mean): 8–18 years |
Hx of migraine: NR |
Outcome: • There was no significant difference in headache scores before vs. after exertional testing. Headaches worsened for 5 subjects and improved for 9 subjects. Mean headache symptom score decreased from 0.97 pre-exertion to 0.78 at 24 h post-exertion (Z = −1.10, p = 0.27), 30-min after exertion was also not significant (p = 0.39, Friedman test) • Overall, the total number of symptoms and symptom severity significantly decreased. There was a significant total decrease in symptoms at 30 min and 24 h post-exertion testing (30 min: severity χ 2 = 14.00, p = 0.001; number χ 2 = 8.7, p = 0.01; 24 h: severity Z = −3.47, p < 0.01) |
(14.8) |
FamHx of migraine: NR |
n = 54 (41% female; 69% completed follow-up) |
**Included 18 years old |
Grabowski et al. (2017)42 |
Retrospective cohort |
Participants were youth athletes with concussion symptoms persisting beyond 3 weeks (80% reported headache at initial visit) |
Migrainous headache: NR Hx of migraine: 20% (also included chronic tension-type headache) |
PT, cardiovascular exercise, vestibular/oculomotor exercise, cervicothoracic manual therapy and exercise, and sports specific training. Mean therapy duration was 84 days (range 7–266) |
Outcome measure: Headache score of how bothersome headaches were from post-concussion symptom scale (PCSS, 0–6). Primary outcome measure was change in total PCSS |
Poor |
Age range (mean): 12–20 years |
FamHx of migraine: NR |
Outcome: • Patients reported significantly decreased PCSS score post-PT. Total PCSS scores: Pre-PT mean 18.2 (SD = 14.2); Post-PT mean 9.1 (SD = 10.8); p < 0.01 • Significance testing was not done on the difference in headache scores pre- versus post-PT. Headache score: Pre-PT median 2 (range 0–5); Post-PT median 1 (range 0–5) • Athletes with a history of chronic migraine or tension-type headache had a mean 10.22 point higher post-PT score compared to athletes with no headache history (p = 0.05) |
(15) |
n = 25 (56% female) |
**Included ≥18 years old |
Bailey et al. (2019)39 |
Pilot, prospective randomized controlled trial |
Participants with concussion at least 4 weeks post-injury (mean 56 days) |
Migrainous headache: NR |
Participants were randomized into the following groups: 1. Sub-threshold exercise program (n = 7): targeted 80% of heart rate that correlated with symptom exacerbation with physiotherapist ×6 weeks 2. Control group (n = 8): instructed on daily stretching activities at home ×3 weeks, then daily walking ×3 weeks |
Outcome measure: % of participants with mild or no headaches defined as a Post-concussion Scale-Revised (PCS-R) headache score of ≤ 2 (0–6 scale). Primary outcome measure was change in total PCS-R score |
Poor |
Age range (mean): 14–18 years |
Hx of migraine: 37% |
Outcome: • Total PCS-R scores decreased more in the intervention than in the control group when depression was accounted for (PCS-R % change: intervention group mean = −63.3%, SD = 17.4; control group mean = −56.8%, SD = −27.8; F 2,13 = 5.20, p < 0.05, partial η2 = 0.32) ANOVA (depression was a covariate). *1 subject from the intervention group was removed prior to analysis due to worsening PCS-R score and high baseline depression score • % with mild or no headache was compared between baseline and post-treatment (intervention group 33% → 67%; control group 33% → 63%). Significance testing was not done |
(15.75) |
FamHx of migraine: NR |
n = 16 (44% female; 1 withdrew due to repeat injury) |
**Included 18 years old |
Wilson et al. (2020)43 |
Retrospective cohort |
Participants seen by a concussion specialist within 21 days of concussion stratified by early physical activity (PA) |
Migrainous headache: NR |
Participants were stratified based on reports of early physical activity (prior to initial evaluation): 1. PA group (n = 69): Reported early physical activity 2. No PA group (n = 506): Reported that they did not have early physical activity |
Outcome measure: Reporting persistent headache at the initial visit. Primary outcome was symptom resolution times |
Poor |
Median days post-injury was 8 for the early PA group and 12 for the no PA group (p < 0.001) |
Hx of migraine: NR |
Outcome: • The no PA group had significantly longer recovery times than the PA group (median 16 IQR 8–24 vs. 10.5 IQR 4–17, p = 0.02) • Subjects in the PA group were significantly less likely to report persistent headache at their initial visit when adjusting for pre-existing headache history (adjusted OR = 0.14, 95% CI: 0.07–0.26) |
Age range (mean): 8–18 years |
FamHx of migraine: NR |
(14.8) |
Note: History of pre-existing headache was reported (28% across the cohort, no significant difference between groups) |
n = 575 (34% female) |
**Included 18 years old |
Collaborative care, cognitive-behavioral therapy, and biofeedback |
McCarty et al. (2021)44 |
Prospective randomized controlled trial |
Participants presented to a concussion clinic within 9 months of concussion/mTBI with ≥3 persistent symptoms at least 1 month after concussion |
Migrainous headache: NR |
Treatment: Cognitive behavioral therapy and care management with enhanced medication consultation if warranted ×6 months |
Outcome measure: Traumatic Brain Injury-Quality of Life Headache Pain (13-item Likert-based scale). Primary outcome measure was improvement in postconcussive symptoms |
Fair |
Age range (median): 11–18 years |
Hx of migraine: NR |
Standard of care: Standard management by subspecialty clinics ×6 months |
Outcome: • There was a significant difference between postconcussive symptom outcomes between the collaborative care group and standard of care group (net difference from baseline between groups mean 3 months −3.4 95% CI: −6.6 to −0.1; mean 6 months −3.0 95% CI: −6.4 to 0.3; mean at 12 months −4.1 95% CI: −7.7 to −0.4; effect size Cohen d at 3 months 0.26 and 12 months 0.32) • No difference in headache outcomes between collaborative care group and standard of care group (net difference from baseline between groups mean 3 months 0.2 95% CI: −1.9 to 2.3; mean 6 months −0.4 95% CI: −2.6 to 1.8; mean at 12 months −1.6 95% CI: −3.9 to 0.7) |
(14.7) |
FamHx of migraine: NR |
n = 200 (62% female) |
Note: 25% reported a history of chronic headaches |
**Included 18 years old |
Schwarz et al. (2017)45 (abstract) |
Retrospective cohort |
Participants received PTH treatment and were evaluated a median of 5.7 months following mTBI |
Migrainous headache: NR |
≥2 biofeedback sessions for treatment of PTH. Compared responders and non-responders |
Outcome measure: % reporting reduced headache frequency, % reporting reduced headache severity |
Poor |
Age range (mean): 8–18 years |
Hx of migraine: NR |
Outcome: • 46% of participants responded to therapy, with 35% reporting reduced headache frequency and 23% reporting reduced severity • Responders were significantly more likely to have stayed in school (χ 2: 5.52, p = 0.02) • Responders were significantly less likely to be on serotonin reuptake inhibitors or tricyclic anti-depressants (χ 2: 3.86, p = 0.05) |
(15.5) |
FamHx of migraine: NR |
n = NR (77% female) |
Note: 66% had daily headaches |
**Included 18 years old |