Objective To present safety and tolerability of treating persistent post-concussive headaches with botulinum toxin A (Botox) in adolescents.

Design Retrospective case series.

Setting A tertiary rehabilitation hospital interdisciplinary outpatient concussion clinic for adolescents aged 12–18 years.

Participants Seven patients ages 15–18 with persistent post-concussion headaches.

Interventions 1. Comprehensive assessment by an interdisciplinary rehab team. 2. Establishing the diagnosis of chronic daily headache disorder with 15 headaches per month, 8 of them meeting pediatric migraine criteria. Headache treatment included neck exercises, physiotherapy, CBT, mindfulness, oral prophylactic and abortive migraine medications as well as Botox. Patients selected had prolonged debilitating headaches, had failed other treatment options, and/or had specific circumstances precluding use of other treatment options, were unable to attend school, tolerate daily activities. 3. Discussion of potential side effects of Botox, complications of injection, review of current literature evidence. Verbal consent obtained.

Clinical monitoring of adverse events of injection, side effects of Botox, effect on daily activities and headaches.

Main results There were no adverse events related to the injection of Botox. Some patients experienced a transient flare up of headaches after injection. All patients reported that injections and post-injection side effects were tolerable. Reduction in headaches was variable.

Conclusions Based on this small clinical sample of adolescents with severe persistent post-concussion headaches, Botox appears to be a well-tolerated and safe treatment option. Prospective, RCT studies are required to confirm this preliminary clinical impression.

Competing interests None.