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

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

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

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

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

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

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

8. 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

9. 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