The following is a summary of “Post-traumatic headache pathophysiology in pediatric concussion: A systematic review,” published in the December 2023 issue of Neurology by Fan et al.

Post-traumatic headache (PTH) is a prevalent and persistent issue among children following a concussion, although the precise reasons behind its occurrence remain uncertain. This comprehensive systematic review aimed to thoroughly analyze the current understanding of PTH’s underlying mechanisms in pediatric concussion cases (ages 0 to 18), evaluate the quality of available evidence, and outline future research directions in line with PRISMA guidelines. A total of 19 eligible studies involving 1,214 individuals with concussions were examined. These studies delved into various aspects such as cerebrovascular function (6 studies), white matter integrity (3 studies), functional connectivity (3 studies), electrophysiology (1 study), neurometabolic (2 studies), biological fluid markers (4 studies), as well as vestibular and oculomotor function (4 studies), with two studies utilizing a multi-modal approach.

Most of these studies were deemed fair quality (90%) and provided Level 3 evidence (84%). However, despite the extensive research, the precise mechanisms triggering PTH after pediatric concussions remain elusive. The quality of available evidence is predominantly weak, carrying a fair risk of bias. Additionally, the characterization of PTH’s pathophysiology suffers from a lack of specificity and relative scarcity of data. Consequently, a clear need exists for future research endeavors to isolate the pathophysiological factors contributing to PTH rigorously. This necessitates strict adherence to clinical definitions and standardized measurement tools designed to assess PTH.

While numerous studies have explored the underlying causes of PTH in children following concussions, the definitive mechanisms remain indistinct. Despite being fairly extensive, the available evidence suffers from quality, bias, and specificity limitations. Therefore, future research should concentrate on refining the understanding of PTH’s pathophysiology through meticulously designed studies that adhere rigorously to defined clinical parameters and employ standardized measurement tools tailored explicitly for PTH assessment in pediatric concussion cases.

Source: sciencedirect.com/science/article/abs/pii/S0149763423004670