Systematic Review of Pre-injury Migraines as a Vulnerability Factor for Worse Outcome Following Sport-Related Concussion

Abstract

BackgroundIndividuals with migraine disorders may be affected differently by concussions compared to individuals without migraine disorders. Prior studies on this topic have had mixed results. The purpose of this study was to systematically examine clinical outcomes following a sport-related concussion in athletes who have a pre-injury history of migraines.MethodsAll studies published prior to 15 May 2021 that examined pre-injury migraines as a possible predictor of clinical recovery from concussion were included. The search included (i) sport/athlete-related terms, (ii) concussion-related terms, and (iii) diverse predictor/modifier terms. After removing duplicates, 5,118 abstracts were screened, 538 full-text articles were reviewed, and 27 articles were included for narrative synthesis without meta-analysis (n = 25 with unique samples). Risk of bias was assessed using the domain-based Quality In Prognosis Studies (QUIPS) tool.ResultsMost studies did not find pre-injury migraines to be associated with concussion outcome, but several of these studies had small or very small sample sizes, as well as other methodological weaknesses. Risk of bias varied greatly across studies. Some of the larger, better-designed studies suggested pre-injury migraines may be a risk factor for worse concussion outcome. Most articles examined pre-injury migraines as an exploratory/secondary predictor of concussion outcome; very few were designed to examine migraine as the primary focus of the study. Migraine history was predominantly based on self-report and studies included minimal information about migraine (e.g., age of onset, frequency/severity, past treatment). Effect sizes were usually not reported or able to be calculated from reported study data.ConclusionThere is some evidence to suggest that pre-injury migraines may be a vulnerability factor for a worse outcome following concussion, with studies having the lowest risk of bias reporting a positive association. Future studies should focus on improving methodological quality when assessing the relationship between pre-injury migraines and concussion outcome and better characterizing pre-injury migraine status.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019128292, identifier: PROSPERO 2019 CRD42019128292.

Assessment and management of sport-related concussion in general practice

“…Recovery times following concussion vary between athletes; the average time for clinical symptom resolution might be influenced by athlete sex, age, and the presence of pre-injury medical or psychological diagnoses. 1,4 Concussion modifiers are factors that might affect SRC recovery and influence a clinician's management, and include: [1][2][3]6,18,21,22 • a high number of concussive symptoms reported • reported severe acute and subacute symptoms • prolonged loss of consciousness (greater than one minute) at the time of the injury • a post-concussive seizure, following the injury • experiencing vestibular-ocular symptoms, such as dizziness and blurred vision • experiencing sleep disturbance in the 10 days after SRC • having a previous history of concussion • the age of the athlete (a more conservative approach is indicated in children)…”

Association of Childhood Trauma with Migraines in Men

“…Migraine is not just a headache; it is a severe neurological condition that could have a variety of negative repercussions on a man's life. Males with migraines are significantly less likely than females to utilize prescription medicines and significantly more likely to use only over-the-counter painkillers [36]. Migraine is a common chronic headache disorder that is characterized by recurrent attacks of moderate to severe pain.…”

Primary Headaches and Physical Performance: A Professional Youth Female Soccer Team Study

“…The role of the pre-traumatic migraine (migraine prior to trauma) in SRC is poorly studied. A few studies have found significant relationships between pre-traumatic migraine and worse SRC consequences [ 10 ]. Zemek et al, conducted the largest cohort study of youths with acute concussion, aged 5− < 18 (N = 3063).…”