Headache Characteristics of Pediatric Sport-Related Concussion

Background: Headache is among the most common symptoms following concussion, yet headache after concussion (HAC) remains poorly characterized. This study describes headache characteristics over the first four weeks following pediatric sport-related concussion. Methods: This is a retrospective case series of 87 athletes (mean: 14.9 years; range: 8.4–18.8 years; 38% female) treated in a specialty sports concussion clinic within 28 days of injury. Primary outcomes of headache consistency, frequency, duration, and associated migrainous symptoms were assessed at immediate (0 to 48 h) and weekly time points over the first 28 days post-injury. Generalized mixed linear models compared headache characteristics across time points. Secondary analyses compared each outcome by as-needed analgesic use. Results: During the immediate post-injury period, headache was more often constant ( p = 0.002) and associated with migrainous symptoms ( p < 0.001). By the third week post-injury, episodic headache was more prevalent ( p < 0.001). Most patients (54%) transitioned from constant, migrainous headache to episodic, non-migrainous headache. This finding was uninfluenced by as-needed analgesic medication use. Conclusions: These findings document the trajectory of HAC. Future studies should assess relationships between initial headache characteristics and recovery.