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Headache is the most common symptom reported after concussion; however, little is known about the incidence of headache and the clinical course over 3 months in pediatric patients with sports-related concussion (SRC) presenting within 30 days of injury.    Methods  Four hundred twenty-five patients met inclusion criteria (patients under 18 years old limited to SRC within 30 days of injury and who also completed a 3 months follow up evaluation) and were enrolled from any 1 of 5 ConTex clinic sites.    Results  Mean age was 14.3 years (range = 7–18, SD 2.2) and mean time since injury at presentation to clinic was 8.1 days (range = 0–30, SD = 6.7). Only 13.7% (n = 56) had a history of headache before their concussion. 96.5% (n = 410) of patients recalled having headache at time of injury. At initial presentation, 77.3% (n = 317) reported headache; 38.2% (n = 121) mild, 48.6% (n = 154) moderate, 13.2% (n = 42) severe (on a scale from 0-6). At 3 months follow up, 19.8% (n = 81) reported headache; 76.6% (n = 62) mild, 18.5% (n = 15) moderate, 4.9% (n = 4) severe. Among 264 that were treated with headache abortive medications, 97.7% (n = 258) used simple analgesics (NSAIDs or acetaminophen); 0.8% (n = 2) used opioids; 10.2% (n = 27) used triptans; and 5.7% (n = 15) used other non-specified treatments. 66.5% of children reported symptom resolution within 29 days (range 0–90 days, mode 17–29, n = 71, 20.2%).    Conclusions  The incidence of headache at the time of concussion is high and remains high within 30 days after injury, the majority of which were moderate in severity. By 3 months, only a minority of patients report headache, the majority of which were mild. For 86.3% of children, their first experience with recurrent headache occurred in the context of SRC. Outcomes were generally good at 3 months despite an overwhelming majority of children being treated with non-specific, simple analgesics. Most children reported symptom resolution within 29 days of injury.

Pediatric headache incidence and outcomes after sports-related concussion: Findings from the North Texas ConcussionRegistry (ConTex)