Headaches after Pediatric Traumatic Brain Injury

Noah Rosen, MD

More than half a million children in the United States sustain a traumatic brain injury (TBI) every year. In a recent study published by Pediatrics, researchers analyzed the prevalence of headaches three and 12 months after mild and moderate or severe TBI in children ages 5 to 17. Three months after a mild TBI, 43 percent of children reported headache, compared to 37 percent of children who had a moderate to severe TBI, and 26 percent of children in the control group. The risk of headache was highest in adolescents and in girls. The researchers concluded that the response to and recovery from TBI is different for children, adolescents and adults and that between boys and girls, there is a difference in symptoms and recovery from TBI.
 
This study is very important for several reasons. First of all, headaches in adolescents and teenagers are often ignored by parents and teachers until it has progressed to the point of disability. This study suggests early awareness and intervention. Secondly, headache disorders during this developmental period can have long term effects because teenagers can miss fundamental information in school that they will have difficulty catching up later. Lastly, undiagnosed post traumatic headache may increase risk for further damage if the teenager continues to play sports without addressing the issue.
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Gabrielle Giffords Surgery to Restore Skull Is Fairly Routine

Rick Madhok, MD

As reported by the Associated Press, Congresswoman Gabrielle Giffords underwent surgery to restore part of her skull that was removed during her initial operation to allow for brain swelling after she suffered a gun-shot wound to the head this past January.

Restoring the part of the skull that was removed is routine if the patient has a good outcome to replace the defect. While this procedure is still considered brain surgery, there are much fewer risks than with the initial operation. To replace the part of the skull, certain types of plastic or titanium mesh can be used to recreate it. Keep in mind, the purpose of the skull is to provide a protective barrier to the brain; this can be accomplished with bone or a specially designed material.

One of the most significant developments in this area is custom-designed implants. As such, using fine computed tomography (CT) scans, each implant is made to fit and recreate the skull so the overall fit is as if the original bone itself were replaced. Custom implants are a major advance in restoring the normal appearance of the skull and a procedure such as the one Congresswoman Giffords is receiving, is relatively common.
 

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