BACKGROUND: Headache-related symptoms may be predictive of delayed recovery in student athletes after sport-related concussion. PURPOSE AND HYPOTHESIS: To compare balance performance, cognitive function, and symptom recovery in concussed student athletes with no headache, those with posttraumatic headache, and those with characteristics of posttraumatic migraine following a sport-related concussion. It was hypothesized that those with posttraumatic migraine would take longer to recover on all clinical measures. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: A total of 296 student athletes who sustained sport-related concussions (migraine, 52; headache, 176; no headache, 68) were evaluated on measures of balance performance, cognition, and symptoms. Patients were categorized into posttraumatic migraine, posttraumatic headache, and no headache groups based on symptoms reported 1 day after injury. Serial testing was conducted with the Balance Error Scoring System, the Standardized Assessment of Concussion, and a graded symptom checklist to evaluate balance performance, cognition, and symptoms, respectively, at baseline, at the time of injury, after the event, and at days 1, 2, 3, 5, 7, and 90. RESULTS: Student athletes with posttraumatic migraine experienced greater symptom severity scores than did those with posttraumatic headache and no headache at the time of injury, after the event, and through day 7 (P < .001 for all). By day 7, symptom severity scores reported by patients with posttraumatic migraine still demonstrated deficits relative to baseline (Δ = 5.6 ± 1.2) compared with patients with headache (Δ = -0.8 ± 0.7) and those with no headache (Δ = -1.4 ± 1.1). Patients with headache experienced greater symptom severity scores than patients with no headache at the time of injury (P < .001), after the event (P < .001), and at day 1 (P < .001), day 2 (P = .005), and day 3 (P = .038). Much smaller differences were observed between the headache and no headache groups beyond day 3 (P > .05). There were no group differences on balance performance (P = .439) and cognitive testing (P = .200) over time. Female patients were 2.13 times more likely than males to report posttraumatic migraine characteristics after concussion. CONCLUSION: Posttraumatic migraine characteristics are related to prolonged symptom recovery after sport-related concussion. Clinicians should exercise caution in making decisions about return to participation for athletes with migraine-like symptoms given the increased short-term impairments and delayed symptom recovery we observed.
BACKGROUND:Headache-related symptoms may be predictive of delayed recovery in student athletes after sport-related concussion. PURPOSE AND HYPOTHESIS: To compare balance performance, cognitive function, and symptom recovery in concussed student athletes with no headache, those with posttraumatic headache, and those with characteristics of posttraumatic migraine following a sport-related concussion. It was hypothesized that those with posttraumatic migraine would take longer to recover on all clinical measures. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: A total of 296 student athletes who sustained sport-related concussions (migraine, 52; headache, 176; no headache, 68) were evaluated on measures of balance performance, cognition, and symptoms. Patients were categorized into posttraumatic migraine, posttraumatic headache, and no headache groups based on symptoms reported 1 day after injury. Serial testing was conducted with the Balance Error Scoring System, the Standardized Assessment of Concussion, and a graded symptom checklist to evaluate balance performance, cognition, and symptoms, respectively, at baseline, at the time of injury, after the event, and at days 1, 2, 3, 5, 7, and 90. RESULTS: Student athletes with posttraumatic migraine experienced greater symptom severity scores than did those with posttraumatic headache and no headache at the time of injury, after the event, and through day 7 (P < .001 for all). By day 7, symptom severity scores reported by patients with posttraumatic migraine still demonstrated deficits relative to baseline (Δ = 5.6 ± 1.2) compared with patients with headache (Δ = -0.8 ± 0.7) and those with no headache (Δ = -1.4 ± 1.1). Patients with headache experienced greater symptom severity scores than patients with no headache at the time of injury (P < .001), after the event (P < .001), and at day 1 (P < .001), day 2 (P = .005), and day 3 (P = .038). Much smaller differences were observed between the headache and no headache groups beyond day 3 (P > .05). There were no group differences on balance performance (P = .439) and cognitive testing (P = .200) over time. Female patients were 2.13 times more likely than males to report posttraumatic migraine characteristics after concussion. CONCLUSION:Posttraumatic migraine characteristics are related to prolonged symptom recovery after sport-related concussion. Clinicians should exercise caution in making decisions about return to participation for athletes with migraine-like symptoms given the increased short-term impairments and delayed symptom recovery we observed.
Authors: Daniel J Corwin; Mark R Zonfrillo; Christina L Master; Kristy B Arbogast; Matthew F Grady; Roni L Robinson; Arlene M Goodman; Douglas J Wiebe Journal: J Pediatr Date: 2014-09-26 Impact factor: 4.406
Authors: Anthony P Kontos; Amit Reches; R J Elbin; Dalia Dickman; Ilan Laufer; Amir B Geva; Galit Shacham; Ryan DeWolf; Michael W Collins Journal: Brain Imaging Behav Date: 2016-06 Impact factor: 3.978
Authors: Michael W Collins; Anthony P Kontos; David O Okonkwo; Jon Almquist; Julian Bailes; Mark Barisa; Jeffrey Bazarian; O Josh Bloom; David L Brody; Robert Cantu; Javier Cardenas; Jay Clugston; Randall Cohen; Ruben Echemendia; R J Elbin; Richard Ellenbogen; Janna Fonseca; Gerard Gioia; Kevin Guskiewicz; Robert Heyer; Gillian Hotz; Grant L Iverson; Barry Jordan; Geoffrey Manley; Joseph Maroon; Thomas McAllister; Michael McCrea; Anne Mucha; Elizabeth Pieroth; Kenneth Podell; Matthew Pombo; Teena Shetty; Allen Sills; Gary Solomon; Danny G Thomas; Tamara C Valovich McLeod; Tony Yates; Ross Zafonte Journal: Neurosurgery Date: 2016-12 Impact factor: 4.654
Authors: Alicia Sufrinko; Jamie McAllister-Deitrick; R J Elbin; Michael W Collins; Anthony P Kontos Journal: J Head Trauma Rehabil Date: 2018 Jan/Feb Impact factor: 2.710