From: Acute and preventive pharmacological treatment of post-traumatic headache: a systematic review
Source | Patient Population, Baseline | Study Design | TBI Severity | Intervention | Follow-up | Eligible Outcome Measures | Major Findings |
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Chan et al. (2015) [12] | 254 children and adolescents, 124 Ma, 130 Fa, mean age 13.8 years | Single-center, ED, tertiary children’s hospital, retrospective | mTBI | Acute Pharmacological Treatment. IV therapies included one of the following four options: - ketorolac only (n = 55) - ketorolac and metoclopramide / prochlorperazine (n = 132) - metoclopramide or prochlorperazine (n = 30) - ondansetron only (n = 37) The dosages used were not reported. Thirty-seven percent of the subjects were pretreated with either acetaminophen or ibuprofen. | None | Treatment success defined as ≥50% reduction in pain intensity as measured on a numeric rating scale from 0 to 10. | Treatment success: - Ketorolac only: 80% - Ketorolac plus metoclopramide or prochlorperazine: 89% - Metoclopramide or prochlorperazine only: 93% - Ondansetron only: 78% |
Dubrovsky et al. (2014) [10] | 28 children, 6 Ma, 22 Fa, mean age 14.6 years | Single-center, tertiary referral center, retrospective | mTBI | Acute Pharmacological Treatment. - GON block (2% lidocaine with epinephrine) - Peripheral nerve blocks of the lesser occipital nerve and supraorbital nerve (only a subgroup of patients) | Follow-up was conducted using a patient satisfaction survey. Five patients lost to follow-up. The exact time from intervention to follow-up could not be extracted properly. | Good therapeutic effect defined as headache relief lasting longer than 24 h or requested repeat blocks. | - 93% with good therapeutic effect - 71% reported complete headache resolution immediately following the intervention - At the follow-up assessment (82% follow-up response rate), 26% of patients reported that peripheral nerve blocks had cured their headache |
Erickson (2011) [15] | 100 military personnel, 99 Ma, 1 Fa, mean age 28.7 years | Single-center, clinic-based, retrospective | mTBI | Acute Pharmacological Treatment. - Triptans (n = 73) - Non-triptans (NSAIDs, acetaminophen, opioids and combination drugsb, n = 33) The dosages were not reported. Notably, 23% used more than one abortive medication. Preventive Pharmacological Treatment. One of the following therapies were prescribed: - Tricyclic antidepressants (amitriptyline or nortriptyline, n = 48) 25–50 mg/day - Topiramate 100 mg/day (n = 29) - Propranolol LA 80 mg/day (n = 18) - Valproate extended release 500 mg/day (n = 5) | 3 months after treatment start, none lost to follow-up. At 3 months post-baseline, 66 of 100 subjects (34% medication discontinuation rate) were still taking the prophylactic treatment that was prescribed at baseline. | Acute Pharmacological Treatment. - Headache relief within two hours after intake (not further specified Preventive Pharmacological Treatment. - Headache frequency defined as number of days in the previous month with a headache lasting > 30 min - Headache-related disability as determined by MIDAS | Acute Pharmacological Treatment. - Triptans (n = 73 and a 70% responder rate) were more effective compared to non-triptans (n = 33 and a 42% responder rate) in terms of headache relief within two hours after intake (P = 0.01) Preventive Pharmacological Treatment. - The decrease in headache frequency was significant for subjects treated with topiramate (n = 29, P = 0.02), but not for any other of the prescribed prophylactic treatments - 57% overall decrease in headache-related disability among all subjects as measured by MIDAS |
Friedman et al. (2018) [11] | 21 adults, 5 M, 16 F, mean age 45 years | Single-center, ED, prospective | NS | Acute Pharmacological Treatment. IV metoclopramide 20 mg + dephenhydramine 25 mg. | 48 h + 7 days, 2 patients lost to follow-up. | “Sustained headache relief for 48 h”, defined as mild headache or no headache sustained for 48 h since ED discharge without use of rescue medication. | - At 48 h since ED discharge, 63% reported sustained headache relief for 48 h, while 37% continued to experience moderate to severe headaches - At the 1-week follow-up, 53% reported no or rare headache occurrence |
Kuczynski et al. (2013) [14] | 44 children, 15 M, 29 F, mean age 14.1 years | Single-center, clinic-based, retrospective | mTBI | Preventive Pharmacological Treatment. The list of prophylactic treatments used included: - Amitriptyline 5 mg to 1 mg/kg (n = 18) - Topiramate 12.5–200 mg/day (n = 6)a - Melatonin 3–10 mg/day (n = 12) - Nortriptyline (n = 9)a and flunarizine (n = 8)a doses were not specified - 17 subjects received more than one treatment i.e. physical therapy and biofeedback therapy | The mean follow-up rate was every 5.5 weeks until headache symptoms had resolved. None lost to follow-up. | Treatment success defined as ≥50% reduction in headache frequency and whether prophylactic treatments were continued for 3 months after headache resolution and subsequently gradually discontinued. | Treatment success: - Amitriptyline: 72% - Melatonin: 75% |
Seeger et al. (2015) [9] | 15 children, 5 M, 10 F, mean age 15.5 years | Single-center, clinic-based, retrospective | mTBI | Acute Pharmacological Treatment. Administration of GON block was done with 2,5 mL 2% lidocaine (50 mg) + 0.5 ml methylprednisolone acetate (20 mg) or 2.5 ml triamcinolone (25 mg). | Follow-up assessment was conducted at a mean of 5.6 months after treatment start, 1 patient lost to follow-up. | Full treatment response defined as ≥50% reduction in headache frequency. | Full treatment response: - 64% (9 of 14 patients) - Mean headache frequency was reduced from 26 days per month to 18 days per month |
Cushman et al. (2019) [13] | 277 children and adults, 139 Ma, 138 Fa, mean age 23.0 yearsa | Single-center, academic sports medicine practice, retrospective | mTBI | Preventive Pharmacological Treatment. Patients were classified into three groups: - No medication (n = 123) - Amitriptyline (median dose: 20 mg, n = 94) - Gabapentin (median dose: 900 mg, n = 60) | Follow-up data was collected over 1 year after treatment start. Study inclusion was dependent on at least one follow-up assessment. | Self-reported headache score, ranging from 0 to 6 (0 = no symptoms, 5–6 = severe symptoms). | - In both medication groups (gabapentin and amitriptyline), headache scores improved over time - However, headache scores improved similarly in the no medication group |