Migraines, Motion Sickness, and Mild Head Injury

Abstract & Commentary

Source: Jan MMS, et al. Vomiting after mild head injury is related to migraine. J Pediatr 1997;130:134-137.

The clinical experience of jan et al in nova Scotia suggested that most children with frequent vomiting after mild head injury have, or will have, migraine headaches. To test this hypothesis, these investigators studied whether vomiting after mild head injury is related to migraine and sought to identify predictors of vomiting after head injury.

Consecutive cases of children with acute head injury evaluated in a Canadian ED were identified. Children evaluated, then admitted to the ED observation unit, and then discharged to home were eligible for study. During a 17-month study period, 47 eligible children were identified; 44 (mean age, 7.4 years) were contacted and interviewed by telephone with a structured questionnaire. Both parents and children were interviewed whenever possible, and all interviews were carried out 10-18 months after the mild head injury. ED charts were reviewed, and the symptoms noted on the charts were confirmed by the parents during the telephone interview. The main topics addressed in the interview were: vomiting at the time of the injury and its frequency; other history of recurrent vomiting; loss of consciousness and its duration; history of recurrent headaches, sleep problems, motion sickness sufficient to cause vomiting, or fainting spells; history of head injury and associated vomiting; history of hospitalization and medication use; and family history of migraine headaches, motion sickness, and fainting spells.

Twenty-nine patients (66%) vomited after the mild head injury, with a median of five episodes of vomiting (range, 1-11). The likelihood of recurrent vomiting was increased if the child had a history of headache (odds ratio [OR], 4.5), and was increased further if the headaches were migrainous (OR, 17.2). All 15 children with a history of motion sickness had recurrent vomiting. Family history of migraine also predicted recurrent vomiting (OR, 20.4).

COMMENT BY LEONARD FRIEDLAND, MD

One evening at the dinner table, the three-year-old sitting next to me bumped her head (loudly) and a few minutes later vomited. Her parents were alarmed and questioned whether they should bring her to the ED. She had no other focal findings and I reassured them that she was fine and that vomiting can occur after mild head injury. They were not pleased to learn that the vomiting could be recurrent and that I couldn’t predict whether it would happen. How to manage the child with vomiting as the only finding after a mild head injury may also be anxiety-provoking for physicians. Should we observe the child in the ED? Order a head CT? Admit to the hospital? What do we tell the parents when they ask what to do if the vomiting persists? The findings from this small retrospective study don’t answer all of these questions, but they suggest that children with a mild head injury are much more likely to vomit if there is a personal history of headaches or migraine headaches, a family history of migraine, or a personal history of motion sickness. Recognition of this association should be useful for our clinical practice.