{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T20:40:20Z","timestamp":1777927220440,"version":"3.51.4"},"reference-count":42,"publisher":"SAGE Publications","issue":"1-2","license":[{"start":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T00:00:00Z","timestamp":1640995200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neurotrauma"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:p>\n                    Children frequently present to an Emergency Department (ED) after concussion, and headache is the most commonly associated symptom. Recent guidelines emphasize the importance of analgesia for post-concussion headache (PCH), yet evidence to inform treatment is lacking. We sought to characterize abortive therapies used to manage refractory PCH in the pediatric ED and factors associated with treatment. A scenario-based survey was distributed to ED physicians at all 15 Canadian tertiary pediatric centers. Participants were asked questions regarding ED treatment of acute (48\u2009h) and persistent (1 month) PCH refractory to appropriate doses of acetaminophen\/ibuprofen. Logistic regression was used to assess factors associated with treatment. Response rate was 63% (137\/219). Nearly all physicians (128\/137, 93%) endorsed treatment in the ED for acute PCH of severe intensity, with most selecting intravenous treatments (116\/137, 84.7%). Treatments were similar for acute and persistent PCH. The most common treatments were metoclopramide (72%), physiologic saline (47%), and nonsteroidal anti-inflammatory agents (NSAIDS; 35%). Second-line ED treatments were more variable. For acute PCH of moderate intensity, overall treatment was lower (102\/137, 74%;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u20090.0001), and NSAIDS (48%) were most frequently selected. In multi-variable regression analyses, no physician- or ED-level factor was associated with receiving treatment, or treatment using metoclopramide specifically. Treatment for refractory PCH in the pediatric ED is highly variable. Importantly, patients with severe PCH are most likely to receive intravenous therapies, often with metoclopramide, despite a paucity of evidence supporting these choices. Further research is urgently needed to establish the comparative effectiveness of pharmacotherapeutic treatments for children with refractory PCH.\n                  <\/jats:p>","DOI":"10.1089\/neu.2020.7508","type":"journal-article","created":{"date-parts":[[2021,3,31]],"date-time":"2021-03-31T07:18:51Z","timestamp":1617175131000},"page":"144-150","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Management of Pediatric Post-Concussion Headaches: National Survey of Abortive Therapies Used in the Emergency Department"],"prefix":"10.1177","volume":"39","author":[{"given":"Kristen","family":"Lambrinakos-Raymond","sequence":"first","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada."},{"name":"UP Centre for Pediatric Emergencies, Brossard, Quebec, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander Sasha","family":"Dubrovsky","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada."},{"name":"UP Centre for Pediatric Emergencies, Brossard, Quebec, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabelle","family":"Gagnon","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada."},{"name":"School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roger","family":"Zemek","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Emergency Medicine and Research Institute, Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brett","family":"Burstein","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada."},{"name":"Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Pediatric Emergency Research Canada (PERC)","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,1,11]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.3979"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2018.6290"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2015.04.011"},{"key":"e_1_3_6_5_2","author":"Babcock L.","unstructured":"Babcock L., , Byczkowski T., , Wade S.L., , Ho M., , Mookerjee S., , and Bazarian J.J. (2013), Predicting postconcussion syndrome after mild traumatic brain injury in children and adolescents who present to the emergency department. JAMA Pediatr. 167, 156\u2013161.","journal-title":"JAMA Pediatr"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2019.02.035"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.1203"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-1742"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.12152"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2018-3074"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1526-4637.2000.99105.x"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2014.10.013"},{"key":"e_1_3_6_13_2","volume-title":"Report to Congress: The Management of TBI in Children","author":"Centers for Disease Control and Prevention","year":"2018","unstructured":"Centers for Disease Control and Prevention. Report to Congress: The Management of TBI in Children. Atlanta, GA: National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention:. 2018."},{"key":"e_1_3_6_14_2","unstructured":"Reed N. Zemek R. Dawson J. and Ledoux A.A. (2020). Living guideline for diagnosing and managing pediatric concussion. Ontario Neurotrauma Foundation. Available at: www.braininjuryguidelines.org\/pediatricconcussion\/. Published 2019. Last accessed May4 2020."},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1186\/2046-4053-2-63"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmrj.2011.06.003"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2017-097699"},{"key":"e_1_3_6_18_2","unstructured":"Pediatric Emergency Research Canada. About Us. www.perc-canada.ca\/pages\/32-about-us. Site. www.perc-canada.ca\/pages\/38-sites. 2020. Last accessed May2 2020."},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2015-0195"},{"key":"e_1_3_6_20_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.080372"},{"key":"e_1_3_6_21_2","volume-title":"Mail and Internet Surveys: The Tailored Design Method\u20142007 Update with New Internet, Visual, and Mixed-Mode Guide","author":"Dillman D.A.","year":"2011","unstructured":"Dillman D.A. Mail and Internet Surveys: The Tailored Design Method\u20142007 Update with New Internet, Visual, and Mixed-Mode Guide. Hoboken, NJ: John Wiley & Sons:. 2011."},{"key":"e_1_3_6_22_2","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.6.3.e34"},{"key":"e_1_3_6_23_2","author":"Fein J.A.","unstructured":"Fein J.A., , Zempsky W.T., , Cravero J.P., Committee on Pediatric Emergency Medicine and Section on Anesthesiology and Pain Medicine, American Academy of Pediastrics. Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics 2012;130, e1391\u2013e1405.","journal-title":"Pediatrics"},{"key":"e_1_3_6_24_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2018.2847"},{"key":"e_1_3_6_25_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2013-092190"},{"key":"e_1_3_6_26_2","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0000000000000084"},{"key":"e_1_3_6_27_2","doi-asserted-by":"publisher","DOI":"10.1093\/pch\/pxw011"},{"key":"e_1_3_6_28_2","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2012-303588"},{"key":"e_1_3_6_29_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0317167100118979"},{"key":"e_1_3_6_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2014.10.015"},{"key":"e_1_3_6_31_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4610.2009.01461.x"},{"issue":"2","key":"e_1_3_6_32_2","first-page":"S406","article-title":"Headache management in concussion and mild traumatic brain injury","volume":"3","author":"Lucas S.","year":"2011","unstructured":"Lucas S. (2011). Headache management in concussion and mild traumatic brain injury. PM R. 3, Suppl 2, S406\u2013S412.","journal-title":"PM R"},{"key":"e_1_3_6_33_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11916-015-0516-x"},{"key":"e_1_3_6_34_2","doi-asserted-by":"publisher","DOI":"10.1111\/head.12737"},{"key":"e_1_3_6_35_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11916-016-0568-6"},{"key":"e_1_3_6_36_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12178-019-09533-x"},{"key":"e_1_3_6_37_2","doi-asserted-by":"publisher","DOI":"10.1097\/00001199-199902000-00004"},{"key":"e_1_3_6_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2015.01.053"},{"key":"e_1_3_6_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2017.10.034"},{"key":"e_1_3_6_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2018.04.007"},{"key":"e_1_3_6_41_2","doi-asserted-by":"publisher","DOI":"10.1177\/0883073814568152"},{"key":"e_1_3_6_42_2","doi-asserted-by":"publisher","DOI":"10.1111\/head.13628"},{"key":"e_1_3_6_43_2","first-page":"e424","article-title":"(2013)","volume":"102","author":"Kinnaman K.A.","unstructured":"Kinnaman K.A., , Mannix R.C., , Comstock R.D., , and Meehan W.P. 3rd. (2013). Management strategies and medication use for treating paediatric patients with concussions. Acta Paediatr. 102, e424\u2013e428.","journal-title":"Management strategies and medication use for treating paediatric patients with concussions. Acta Paediatr"}],"container-title":["Journal of Neurotrauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/neu.2020.7508","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/neu.2020.7508","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/neu.2020.7508","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T22:38:08Z","timestamp":1777675088000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/neu.2020.7508"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1]]},"references-count":42,"journal-issue":{"issue":"1-2","published-print":{"date-parts":[[2022,1]]}},"alternative-id":["10.1089\/neu.2020.7508"],"URL":"https:\/\/doi.org\/10.1089\/neu.2020.7508","relation":{},"ISSN":["0897-7151","1557-9042"],"issn-type":[{"value":"0897-7151","type":"print"},{"value":"1557-9042","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1]]}}}