Researchers from Nationwide Children’s Hospital in Columbus, Ohio recently reported findings at the Child Neurology Society 2013 Annual Meeting that overuse of analgesics after concussion may fuel headache.

Geoffrey L. Heyer, MD, from Nationwide Children’s Hospital told Medscape Medical News that for the past 3 years sports medicine doctors and pediatricians/primary care doctors have been sending their concussion patients with persistent postconcussion symptoms to Nationwide.

“We began noticing that a lot of these adolescents and young adults had been instructed to take analgesics during their acute concussion management, but the medicines were never decreased or stopped as the headaches became chronic,” said Dr. Heyer. By the time patients entered the clinic in Columbus, many had been taking over-the-counter analgesics 2 to 3 times a day for several months. Dr. Heyer noted, “As frequent and prolonged use of headache medicines (including simple analgesics) can cause a medication overuse headache, we decided to look back at patient outcomes once the analgesics were stopped.”

In looking at 104 adolescent patients with concussion, the researchers found that 77 had chronic post-traumatic headache lasting between 3 and 12 months. Fifty four of these patients, or 70.1% met criteria for probable medication-overuse headache.

Dr. Heyer believes that when daily headaches following concussion continue for several weeks, clinicians should consider stopping analgesics or restricting their use to no more than 2 days weekly.

Rosemarie Scolaro Moser, PhD, neuropsychologist and director of the Sports Concussion Center of New Jersey, Lawrenceville advised caution in drawing conclusions from the Nationwide study. Because 68.5% of patients with medication-overuse headache had resolution of their headaches, or a return to their preconcussion headache after stopping the analgesic, it “could also be explained by spontaneous healing; concussions do resolve and get better on their own, so I am not sure if taking the patients off the analgesics was what made them get better over a 2-month period,” said Dr. Moser.

She suggested parents and adolescents work with physicians and headache specialists who understand concussion, and are careful about monitoring the use of medications during the recovery period. Dr. Moser also suggested that working with a psychotherapist, neuropsychologist or biofeedback specialist may also help…….Medscape Medical News     11/5/13


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