Preinjury Migraine History as a Risk Factor for Prolonged Return to School and Sports following Concussion

Abstract

Having a preexisting migraine disorder might be a risk factor for a prolonged recovery following a sport-related concussion. We examined whether having a migraine history was associated with a prolonged return to academics and athletics following a concussion. High school and collegiate athletes (n = 1265; 42% female) who sustained a sport-related concussion were monitored by athletic trainers using a web-based surveillance system that collects information about concussion recovery. Nonparametric Kolmogorov-Smirnov tests (KS) were used to compare days to return to academics/athletics across groups due to non-normally distributed outcome variables and unequal distributions of scores between groups. Chi-squared tests were used to examine the proportion of players who had not returned to academics/athletics at 7, 14, and 21 days post-injury stratified by self-reported migraine history. There were 117 athletes (9.2%) who reported a preinjury migraine history. Athletes with a history of migraine took a median of 6 days to return to academics (mean [M] = 10.6, standard deviation [SD] = 14.2) and 15.5 days to return to athletics (M = 23.8, SD = 30.8), while those with no migraine history took a median of 5 days to return to academics (M = 7.5, SD = 10.9) and 14 days to return to athletics (M = 19.4, SD = 19.4). There were no statistically significant differences in days to return to school or athletics between the groups (KS p > 0.05). However, a lower percentage of athletes with a history of migraine had returned to school after 7 days (57% vs. 68%, χ = 5.53, p = 0.02), 14 days (75% vs. 88%, χ = 14.21, p < 0.001), and 21 days post-injury (89% vs. 94%, χ = 4.90, p = 0.03). Stratifying the analyses by sex showed that this effect was significant in girls and women with preexisting migraines, but not boys and men with preexisting migraines. There were no group differences in recovery rates when examining return to athletics. Athletes with a preinjury migraine history may be at an elevated risk for a protracted return to school after concussion, especially girls and women.

A Physiological Approach to Assessment and Rehabilitation of Acute Concussion in Collegiate and Professional Athletes

“…Although the pathophysiology of migraine with aura is characterized by cortical spreading depression, alterations in cerebral blood flow, and activation of trigeminal nocioceptive pathways (118, 122–124), the pathophysiology of migraine without aura remains less understood. Consistent with more recent research (125), it is our experience that the majority of collegiate and professional athletes with a history of migraine and acute concussion will make a complete recovery along expected timelines. However, for those experiencing more frequent or severe migraine headaches following acute concussion, we recommend early referral to a headache neurologist to consider a short course of pharmacological treatment that should be discontinued prior to medical clearance (126).…”

Pediatric Post‐Traumatic Headache and Implications for Return to Sport: A Narrative Review

“…The development of migraine post‐injury has been associated with an increased risk of persistent post‐concussive symptoms and poorer performance on neuropsychological and cognitive tests when compared to athletes with other types of headache or no headache at all 103,106‐109 . A recent retrospective study in those with a mTBI and a pre‐injury history of migraine noted a protracted return to school and sports in females only, 110 but only by one day, which is of uncertain clinical significance. Others have disputed the association between having pre‐existing migraine or family history of migraine and having a prolonged recovery post‐mTBI 24,111‐118 .…”

The cost of a single concussion in American high school football: a retrospective cohort study

“…Relevant pre-injury clinical variables, including demographics and medical/family history as well as injury characteristics (loss of consciousness, antero- or retrograde-amnesia) were chosen based on published literature demonstrating importance of these variables in predicting prolonged recovery [ 14–18 ]. Initial symptoms and severity upon presentation to sports concussion clinic were documented using the commonly used and validated post-concussion symptom scale (PCSS) [ 19 , 20 ], which contains 22 symptoms rated on a Likert scale from 0 to 6 (least to most severe), yielding a maximum score of 132 [ 20 ].…”