Posttraumatic migraine characteristics in athletes following sports-related concussion

Jason P. Mihalik Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Allied Health Sciences, School of Medicine, University of North Carolina, Chapel Hill, North Carolina; and Department of Neurosurgery, Florida Hospital Neuroscience Institute and Center for Sports-Related Craniospinal Injuries, Orlando, Florida

Search for other papers by Jason P. Mihalik in
Current site
Google Scholar
PubMed Close
 B.Sc.
,
Jamie E. Stump Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Allied Health Sciences, School of Medicine, University of North Carolina, Chapel Hill, North Carolina; and Department of Neurosurgery, Florida Hospital Neuroscience Institute and Center for Sports-Related Craniospinal Injuries, Orlando, Florida

Search for other papers by Jamie E. Stump in
Current site
Google Scholar
PubMed Close
 Ph.D.
,
Michael W. Collins Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Allied Health Sciences, School of Medicine, University of North Carolina, Chapel Hill, North Carolina; and Department of Neurosurgery, Florida Hospital Neuroscience Institute and Center for Sports-Related Craniospinal Injuries, Orlando, Florida

Search for other papers by Michael W. Collins in
Current site
Google Scholar
PubMed Close
 Ph.D.
,
Mark R. Lovell Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Allied Health Sciences, School of Medicine, University of North Carolina, Chapel Hill, North Carolina; and Department of Neurosurgery, Florida Hospital Neuroscience Institute and Center for Sports-Related Craniospinal Injuries, Orlando, Florida

Search for other papers by Mark R. Lovell in
Current site
Google Scholar
PubMed Close
 Ph.D.
,
Melvin Field Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Allied Health Sciences, School of Medicine, University of North Carolina, Chapel Hill, North Carolina; and Department of Neurosurgery, Florida Hospital Neuroscience Institute and Center for Sports-Related Craniospinal Injuries, Orlando, Florida

Search for other papers by Melvin Field in
Current site
Google Scholar
PubMed Close
 M.D.
, and
Joseph C. Maroon Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Allied Health Sciences, School of Medicine, University of North Carolina, Chapel Hill, North Carolina; and Department of Neurosurgery, Florida Hospital Neuroscience Institute and Center for Sports-Related Craniospinal Injuries, Orlando, Florida

Search for other papers by Joseph C. Maroon in
Current site
Google Scholar
PubMed Close
 M.D.
Page Range:
850–855
Volume/Issue:
Volume 102: Issue 5
DOI link:
https://doi.org/10.3171/jns.2005.102.5.0850
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $525.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $624.00
Click here for subscription options

  • Purchase Now

    USD  $45.00

  • JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

    USD  $525.00

  • JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

    USD  $624.00
USD  $45.00
USD  $525.00
USD  $624.00
Print or Print + Online Sign in

Object. The object of this study was to compare symptom status and neurocognitive functioning in athletes with no headache (non-HA group), athletes complaining of headache (HA group), and athletes with characteristics of posttraumatic migraine (PTM group).

Methods. Neurocognitive tests were undertaken by 261 high-school and collegiate athletes with a mean age of 16.36 ± 2.6 years. Athletes were separated into three groups: the PTM group (74 athletes with a mean age of 16.39 ± 3.06 years), the HA group (124 athletes with a mean age of 16.44 ± 2.51 years), and the non-HA group (63 patients with a mean age of 16.14 ± 2.18 years). Neurocognitive summary scores (outcome measures) for verbal and visual memory, visual motor speed, reaction time, and total symptom scores were collected using ImPACT, a computer software program designed to assess sports-related concussion.

Significant differences existed among the three groups for all outcome measures. The PTM group demonstrated significantly greater neurocognitive deficits when compared with the HA and non-HA groups. The PTM group also exhibited the greatest amount of departure from baseline scores.

Conclusions. The differences among these groups can be used as a basis to argue that PTM characteristics triggered by sports-related concussion are related to increased neurocognitive dysfunction following mild traumatic brain injury. Thus, athletes suffering a concussion accompanied by PTM should be examined in a setting that includes symptom status and neurocognitive testing to address their recovery more fully. Given the increased impairments observed in the PTM group, in this population clinicians should exercise increased caution in decisions about treatment and when the athlete should be allowed to return to play.

  • Collapse
  • Expand

Contributor Notes

Address reprint requests to: Mark R. Lovell, Ph.D., University of Pittsburgh Medical Center Sports Medicine Concussion Program, 3200 South Water Street, Pittsburgh, Pennsylvania 15203. email: lovellmr@upmc.edu.
  • 1.

    American Association for the Study of Headache International Headache Society: Consensus statement on improving migraine management. Headache 38:736, 1998 American Association for the Study of Headache International Headache Society: Consensus statement on improving migraine management. Headache 38:736, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Brown SJ, , Fann JR, & Grant I: Postconcussional disorder: time to acknowledge a common source of neurobehavioral morbidity. J Neuropsychiatry Clin Neurosci 6:15–22, 1994 Brown SJ, Fann JR, Grant I: Postconcussional disorder: time to acknowledge a common source of neurobehavioral morbidity. J Neuropsychiatry Clin Neurosci 6:15–22, 1994

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Collins MW, , Field M, , Lovell MR, , Iverson G, , Johnston KM, & Maroon J, et al: Relationship between postconcussion headache and neuropsychological test performance in high school athletes. Am J Sports Med 31:168–173, 2003 Collins MW, Field M, Lovell MR, Iverson G, Johnston KM, Maroon J, et al: Relationship between postconcussion headache and neuropsychological test performance in high school athletes. Am J Sports Med 31:168–173, 2003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Collins MW, , Grindel SH, , Lovell MR, , Dede DE, , Moser DJ, & Phalin BR, et al: Relationship between concussion and neuropsychological performance in college football players. JAMA 282:964–970, 1999 Collins MW, Grindel SH, Lovell MR, Dede DE, Moser DJ, Phalin BR, et al: Relationship between concussion and neuropsychological performance in college football players. JAMA 282:964–970, 1999

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Collins MW, , Iverson GL, , Lovell MR, , McKeag DB, , Norwig J, & Maroon J: On-field predictors of neuropsychological and symptom deficit following sports-related concussion. Clin J Sport Med 13:222–229, 2003 Collins MW, Iverson GL, Lovell MR, McKeag DB, Norwig J, Maroon J: On-field predictors of neuropsychological and symptom deficit following sports-related concussion. Clin J Sport Med 13:222–229, 2003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Collins MW, , Lovell MR, , Iverson GL, , Cantu RC, , Maroon JC, & Field M: Cumulative effects of concussion in high school athletes. Neurosurgery 51:1175–1181, 2002 Collins MW, Lovell MR, Iverson GL, Cantu RC, Maroon JC, Field M: Cumulative effects of concussion in high school athletes. Neurosurgery 51:1175–1181, 2002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Collins MW, , Lovell MR, & McKeag DB: Current issues in managing sports-related concussion. JAMA 282:2283–2285, 1999 Collins MW, Lovell MR, McKeag DB: Current issues in managing sports-related concussion. JAMA 282:2283–2285, 1999

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Denny-Brown D, & Yanagisawa N: The function of the descending root of the fifth nerve. Brain 96:783–814, 1973 Denny-Brown D, Yanagisawa N: The function of the descending root of the fifth nerve. Brain 96:783–814, 1973

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Field M, , Collins MW, , Lovell MR, & Maroon J: Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes. J Pediatr 142:546–553, 2003 Field M, Collins MW, Lovell MR, Maroon J: Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes. J Pediatr 142:546–553, 2003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Gerberich SG, , Priest JD, , Boen JR, , Straub CP, & Maxwell RE: Concussion incidences and severity in secondary school varsity football players. Am J Public Health 73:1370–1375, 1983 Gerberich SG, Priest JD, Boen JR, Straub CP, Maxwell RE: Concussion incidences and severity in secondary school varsity football players. Am J Public Health 73:1370–1375, 1983

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Gilkey SJ, , Ramadan NM, , Aurora TK, & Welch KM: Cerebral blood flow in chronic posttraumatic headache. Headache 37:583–587, 1997 Gilkey SJ, Ramadan NM, Aurora TK, Welch KM: Cerebral blood flow in chronic posttraumatic headache. Headache 37:583–587, 1997

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Guskiewicz KM, , McCrea M, , Marshall SW, , Cantu RC, , Randolph C, & Barr W, et al: Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study. JAMA 290:2549–2555, 2003 Guskiewicz KM, McCrea M, Marshall SW, Cantu RC, Randolph C, Barr W, et al: Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study. JAMA 290:2549–2555, 2003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Guskiewicz KM, , Ross SE, & Marshall SW: Postural stability and neuropsychological deficits after concussion in collegiate athletes. J Athl Train 36:263–273, 2001 Guskiewicz KM, Ross SE, Marshall SW: Postural stability and neuropsychological deficits after concussion in collegiate athletes. J Athl Train 36:263–273, 2001

    • Search Google Scholar
    • Export Citation
  • 14.

    Guskiewicz KM, , Weaver NL, , Padua DA, & Garrett WE Jr: Epidemiology of concussion in collegiate and high school football players. Am J Sports Med 28:643–650, 2000 Guskiewicz KM, Weaver NL, Padua DA, Garrett WE Jr: Epidemiology of concussion in collegiate and high school football players. Am J Sports Med 28:643–650, 2000

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Haas DC: Chronic posttraumatic headache, in Olesen J, , Tfelt-Hansen P, & Welsh KM (eds): The Headaches. New York: Raven Press, 1993, pp 629–637 Haas DC: Chronic posttraumatic headache, in Olesen J, Tfelt-Hansen P, Welsh KM (eds): The Headaches. New York: Raven Press, 1993, pp 629–637

    • Search Google Scholar
    • Export Citation
  • 16.

    Haas DC: Chronic post-traumatic headaches classified and compared with natural headaches. Cephalalgia 16:486–493, 1996 Haas DC: Chronic post-traumatic headaches classified and compared with natural headaches. Cephalalgia 16:486–493, 1996

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Iverson GL, , Gaetz M, , Lovell MR, & Collins MW: Cumulative effects of concussion in amateur athletes. Brain Inj 18:433–443, 2004 Iverson GL, Gaetz M, Lovell MR, Collins MW: Cumulative effects of concussion in amateur athletes. Brain Inj 18:433–443, 2004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Iverson GL, , Gaetz M, , Lovell MR, & Collins MW: Relation between subjective fogginess and neuropsychological testing following concussion. J Int Neuropsychol Soc 10:904–906, 2004 Iverson GL, Gaetz M, Lovell MR, Collins MW: Relation between subjective fogginess and neuropsychological testing following concussion. J Int Neuropsychol Soc 10:904–906, 2004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Iverson GL, , Lovell MR, & Collins MW: Interpreting change on ImPACT following sport concussion. Clin Neuropsychol 17:460–467, 2003 Iverson GL, Lovell MR, Collins MW: Interpreting change on ImPACT following sport concussion. Clin Neuropsychol 17:460–467, 2003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Johnston KM, , McCrory P, , Mohtadi NG, & Meeuwisse W: Evidence-Based review of sport-related concussion: clinical science. Clin J Sport Med 11:150–159, 2001 Johnston KM, McCrory P, Mohtadi NG, Meeuwisse W: Evidence-Based review of sport-related concussion: clinical science. Clin J Sport Med 11:150–159, 2001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Johnston KM, , Ptito A, , Chankowsky J, & Chen JK: New frontiers in diagnostic imaging in concussive head injury. Clin J Sport Med 11:166–175, 2001 Johnston KM, Ptito A, Chankowsky J, Chen JK: New frontiers in diagnostic imaging in concussive head injury. Clin J Sport Med 11:166–175, 2001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Katz RT, & DeLuca J: Sequelae of minor traumatic brain injury. Am Fam Physician 46:1491–1498, 1992 Katz RT, DeLuca J: Sequelae of minor traumatic brain injury. Am Fam Physician 46:1491–1498, 1992

    • Search Google Scholar
    • Export Citation
  • 23.

    Larsson LI, , Edvinsson L, , Fahrenkrug J, , Hakanson R, , Owman C, & Schaffalitzky de Muckadell O, et al: Immunohistochemical localization of a vasodilatory polypeptide (VIP) in cerebrovascular nerves. Brain Res 113:400–404, 1976 Larsson LI, Edvinsson L, Fahrenkrug J, Hakanson R, Owman C, Schaffalitzky de Muckadell O, et al: Immunohistochemical localization of a vasodilatory polypeptide (VIP) in cerebrovascular nerves. Brain Res 113:400–404, 1976

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Lauritzen M: Pathophysiology of the migraine aura. The spreading depression theory. Brain 117:199–210, 1994 Lauritzen M: Pathophysiology of the migraine aura. The spreading depression theory. Brain 117:199–210, 1994

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Leclerc S, , Lassonde M, , Delaney JS, , Lacroix VJ, & Johnston KM: Recommendations for grading of concussion in athletes. Sports Med 31:629–636, 2001 Leclerc S, Lassonde M, Delaney JS, Lacroix VJ, Johnston KM: Recommendations for grading of concussion in athletes. Sports Med 31:629–636, 2001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Lovell MR, & Collins MW: Neuropsychological assessment of the college football player. J Head Trauma Rehabil 13:9–26, 1998 Lovell MR, Collins MW: Neuropsychological assessment of the college football player. J Head Trauma Rehabil 13:9–26, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Lovell MR, , Collins MW, , Iverson GL, , Field M, , Maroon JC, & Cantu R, et al: Recovery from mild concussion in high school athletes. J Neurosurg 98:296–301, 2003 Lovell MR, Collins MW, Iverson GL, Field M, Maroon JC, Cantu R, et al: Recovery from mild concussion in high school athletes. J Neurosurg 98:296–301, 2003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28.

    Lovell MR, , Collins MW, , Iverson GL, , Johnston KM, & Bradley JP: Grade 1 or “ding” concussions in high school athletes. Am J Sports Med 32:47–54, 2004 Lovell MR, Collins MW, Iverson GL, Johnston KM, Bradley JP: Grade 1 or “ding” concussions in high school athletes. Am J Sports Med 32:47–54, 2004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Mandel S: Minor head injury may not be “minor.” Postgrad Med 85:213–217, 220, 225, 1989 Mandel S: Minor head injury may not be “minor.” Postgrad Med 85:213–217, 220, 225, 1989

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30.

    Margulies S: The postconcussion syndrome after mild head trauma Part II: is migraine underdiagnosed? J Clin Neurosci 7:495–499, 2000 Margulies S: The postconcussion syndrome after mild head trauma Part II: is migraine underdiagnosed? J Clin Neurosci 7:495–499, 2000

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31.

    Maroon JC, , Lovell MR, , Norwig J, , Podell K, , Powell JW, & Hartl R: Cerebral concussion in athletes: evaluation and neuropsychological testing. Neurosurgery 47:659–672, 2000 Maroon JC, Lovell MR, Norwig J, Podell K, Powell JW, Hartl R: Cerebral concussion in athletes: evaluation and neuropsychological testing. Neurosurgery 47:659–672, 2000

    • Search Google Scholar
    • Export Citation
  • 32.

    McCrea M, , Guskiewicz KM, , Marshall SW, , Barr W, , Randolph C, & Cantu RC, et al: Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. JAMA 290:2556–2563, 2003 McCrea M, Guskiewicz KM, Marshall SW, Barr W, Randolph C, Cantu RC, et al: Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. JAMA 290:2556–2563, 2003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33.

    Mittenberg W, & Strauman S: Diagnosis of mild head injury and the postconcussion syndrome. J Head Trauma Rehabil 15:783–791, 2000 Mittenberg W, Strauman S: Diagnosis of mild head injury and the postconcussion syndrome. J Head Trauma Rehabil 15:783–791, 2000

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34.

    Packard RC: Epidemiology and pathogenesis of posttraumatic headache. J Head Trauma Rehabil 14:9–21, 1999 Packard RC: Epidemiology and pathogenesis of posttraumatic headache. J Head Trauma Rehabil 14:9–21, 1999

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35.

    Packard RC, & Ham LP: Pathogenesis of posttraumatic headache and migraine: a common headache pathway? Headache 37:142–152, 1997 Packard RC, Ham LP: Pathogenesis of posttraumatic headache and migraine: a common headache pathway? Headache 37:142–152, 1997

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36.

    Pernow B: Substance P. Pharmacol Rev 35:85–141, 1983 Pernow B: Substance P. Pharmacol Rev 35:85–141, 1983

  • 37.

    Solomon S: John Graham Senior Clinicians Award Lecture. Posttraumatic migraine. Headache 38:772–778, 1998 Solomon S: John Graham Senior Clinicians Award Lecture. Posttraumatic migraine. Headache 38:772–778, 1998

    • Search Google Scholar
    • Export Citation
  • 38.

    Sosin DM, , Sniezek JE, & Thurman DJ: Incidence of mild and moderate brain injury in the United States, 1991. Brain Inj 10:47–54, 1996 Sosin DM, Sniezek JE, Thurman DJ: Incidence of mild and moderate brain injury in the United States, 1991. Brain Inj 10:47–54, 1996

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 39.

    Speed WG: Post-traumatic headache, in Diamond S, & Dalessio DJ (eds): The Practicing Physician's Approach to Headache, ed 4. Baltimore: Williams & Wilkins, 1986, pp 113–119 Speed WG: Post-traumatic headache, in Diamond S, Dalessio DJ (eds): The Practicing Physician's Approach to Headache, ed 4. Baltimore: Williams & Wilkins, 1986, pp 113–119

    • Search Google Scholar
    • Export Citation
  • 40.

    Taylor AR, & Bell TK: Slowing of cerebral circulation after concussional head injury. A controlled trial. Lancet 2:178–180, 1966 Taylor AR, Bell TK: Slowing of cerebral circulation after concussional head injury. A controlled trial. Lancet 2:178–180, 1966

    • Search Google Scholar
    • Export Citation
  • 41.

    Thurman DJ, , Branche CM, & Sniezek JE: The epidemiology of sports-related traumatic brain injuries in the United States: recent developments. J Head Trauma Rehabil 13:1–8, 1998 Thurman DJ, Branche CM, Sniezek JE: The epidemiology of sports-related traumatic brain injuries in the United States: recent developments. J Head Trauma Rehabil 13:1–8, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 42.

    Triplett G, , Hill C, , Freeman L, , Rajan U, & Templer DI: Incidence of head injury: lasting effects among college students and working adults in the general population. Percept Mot Skills 83:1344–1346, 1996 Triplett G, Hill C, Freeman L, Rajan U, Templer DI: Incidence of head injury: lasting effects among college students and working adults in the general population. Percept Mot Skills 83:1344–1346, 1996

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43.

    Weiss HD, , Stern BJ, & Goldberg J: Post-traumatic migraine: chronic migraine precipitated by minor head or neck trauma. Headache 31:451–456, 1991 Weiss HD, Stern BJ, Goldberg J: Post-traumatic migraine: chronic migraine precipitated by minor head or neck trauma. Headache 31:451–456, 1991

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 44.

    Yamaguchi M: Incidence of headache and severity of head injury. Headache 32:427–431, 1992 Yamaguchi M: Incidence of headache and severity of head injury. Headache 32:427–431, 1992

    • Crossref
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 2212 494 42
Full Text Views 287 21 3
PDF Downloads 141 18 1
EPUB Downloads 0 0 0