MANAGEMENT OF CHRONIC HEADACHES IN PEDIATRIC POST-CONCUSSION SYNDROME Susan Beaird, DNP, CPNP Lauren King, MSN, CPNP

Concussion Pathophysiology Concussion Initial injury Cell damage Increased metabolic need Secondary Inflammation Response to cell damage Decreased cerebral perfusion Kids > Adults

So Why Rest?  “Metabolic Mismatch” Physical Activity Cognitive Activity Increased metabolic demand

Concussion vs. Postconcussion Syndrome  Concussion: symptoms ≤ 2 weeks  Postconcussion syndrome: symptoms ≥ 4 weeks Concussion Physical Cognitive Sleep Emotional

Risk for Postconcussion Syndrome  Overexertion during recovery phase  Previous head injury  Comorbid conditions  Primary headache disorder  Mood disorder  ADD/ADHD  ??

Management of Postconcussion Syndrome  Time and Rest  Symptom management  Headaches  neurology  School and learning issues  neuropsychology  Dizziness and balance issues  vestibular rehabilitation

Headache Management in Postconcussion Syndrome  Education and Expectations  Lifestyle  Nutraceuticals  Medications  Acute  Prophylactic

Conclusion  Common personality traits  Family history of “brain things”  You’ll need a box of tissues  Predictive qualities  Risk  Recovery  Structured return to activities for postconcussion patients What we’ve learnedWhat we hope to learn

Our Team  Lauren E. King, MSN, CPNP  Susan E. Beaird, DNP, CPNP  R. Steven Couch, MD  Assistant professor of pediatrics  Division of Developmental Medicine  Associate medical director of pediatric rehab at Vanderbilt Stallworth Rehabilitation Hospital Pediatric NeurologyPediatric Rehabilitation