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Efficacy of outpatient infusion therapy in pediatric patients with postconcussive headaches

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Abstract

Purpose

To determine the relative efficacy of intravenous therapy for postconcussive headaches in a pediatric population, as compared to oral therapy.

Methods

Pediatric patients treated for postconcussive headaches at an outpatient infusion clinic from 2016 to 2018 were selected for inclusion in the study. Of the 95 patients who were treated in clinic, 53 patients were selected for a retrospective chart review. Clinic visits before and after infusions were reviewed to determine changes in headache score (HA), symptom severity score (SSS), and self-reported symptom relief. An age-matched and SSS-matched group served as a control. The control group received only oral therapy for their headaches. The infusion consisted of parenteral ketorolac, compazine, diphenhydramine, and a normal saline bolus (20 mg/kg).

Results

Following infusion therapy, overall mean HA and SSS scores were both reduced (p < 0.0001). Oral therapy demonstrated a similar mean overall reduction in HA and SS scores (p < 0.0001). While both groups achieved a reduction in HA and SS scores, there was not a statistically significant difference in reduction of symptoms scores between the oral and infusion groups.

Conclusion

Infusion therapy is as effective at reducing HA and SSS as established oral therapies. Infusion therapy may have a shorter time to headache abortion than oral therapy based on pharmacokinetics. Further, some physicians are unwilling to allow an athlete to return to play while taking suppressive medication. Future studies may show that an infusion could allow a more rapid return to play and resolution of symptoms.

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Authors and Affiliations

  1. School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    James Pate, Erin Katz & Carly Cignetti

  2. Department of Neurosurgery, University of Alabama at Birmingham, 1802 6th Avenue South, FOT 1001, Birmingham, AL, 35233, USA

    James Mooney

  3. Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA

    Chandler McLeod

  4. Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA

    Sara Gould

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  1. James Pate
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  2. James Mooney
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  3. Erin Katz
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Correspondence to James Mooney.

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Pate, J., Mooney, J., Katz, E. et al. Efficacy of outpatient infusion therapy in pediatric patients with postconcussive headaches. Childs Nerv Syst 38, 103–108 (2022). https://doi.org/10.1007/s00381-021-05383-6

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  • DOI: https://doi.org/10.1007/s00381-021-05383-6

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