Pediatric post-traumatic headaches and peripheral nerve blocks of the scalp: a case series and patient satisfaction survey

Objective: This study's objective is to characterize the therapeutic effect of peripheral nerve blocks of the scalp for children and adolescents with post-traumatic headaches.

Background: Headaches are the most frequently reported persistent symptoms following a pediatric mild traumatic brain injury, may be challenging to treat, and can transform into debilitating chronic headaches. The beneficial use of peripheral nerve blocks of the scalp has been reported for adults with post-traumatic headaches.

Methods: Retrospective case series on all patients <18 years of age treated between January 2012 and June 2013 in the mild traumatic brain injury clinic with a nerve block. The main outcome measure was the proportion of patients with a good therapeutic effect, defined by the duration of the block being >24 hours and/or repeat blocks requested. A data extractor blinded to main outcome measures performed the chart review. A patient satisfaction survey was also sent to all patients to assess the recalled experience with the interventions received.

Results: A total of 62 nerve blocks were performed on 28 patients for 30 injuries that led to post-traumatic headaches. The mean (standard deviation) age was 14.6 (1.7) years. The first nerve blocks were performed a mean (standard deviation) of 70 (54.2) days post-injury. The therapeutic effect was good in 93% of patients with 71% reporting immediate complete relief of their headaches; the mean percent headache reduction was 94%. Most (91%) would recommend a nerve block for post-traumatic headaches.

Conclusion: The ease with which peripheral nerve blocks of the scalp can be performed combined with the immediate relief experienced by patients makes them a potential addition to the armamentarium of headache management strategies for children and adolescent with post-traumatic headaches.