Importance of Headache Symptoms in Concussion Recovery and Management

Concussion ClinicResearch investigating when it is safe for a person to return to play / participation following injury has long been a focus of faculty within Exercise and Sport Science.  Traumatic brain injury is one area where this work has received considerable attention and made a significant impact on clinical practice.  For nearly 20 years, faculty and students in Exercise and Sport Science have led the way in understanding the recovery process, establishing guidelines for return to play, identifying injury mechanisms, and developing rehabilitation strategies for individuals suffering traumatic brain injury.  This research has contributed to new legislative efforts across the country to better protect individuals who’ve suffered a sport-related traumatic brain injury.  This week’s EXSS impact blog post highlights the recent work of Dr. Jason Mihalik, who co-directs the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center.  Specifically, this research investigates the influence of headache on the recovery process following a sport-related concussion (click here for the full article). 

Why we performed this study?

Traumatic brain injury (TBI) is considered by the Centers for Disease Control and Prevention to be a serious public health problem in the United States. It has been estimated that between 1.6 and 3.8 million sport-related TBIs occur each year in the United States. In addition to representing one of the most difficult clinical conditions to manage in sports medicine, TBI (mild through severe) is responsible for costs of US$60 billion in direct medical and indirect costs, making TBI among the most expensive conditions to treat in adolescents. Children younger than 15 years represent as much as 40% of the 1.1 million TBIs—not all specific to sports—that result in emergency department visits each year. However, treatment for concussion remains a wait-and-see approach, monitoring symptom resolution. Therefore, understanding the prognostic capability of symptoms may help direct clinicians to specific treatment interventions.

The work we do in the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center holistically approaches sport-related head trauma from many different facets. In particular to headache, our previous work in this area identified that athletes reporting migraine-like characteristics (headache, nausea, and sensitivity to light or noise) experienced more pronounced acute deficits as measured by a multi-pronged clinical evaluation approach encompassing neurocognition, balance, and symptom reporting. While immediate deficits were observed in our group of migraine-like sufferers (compared to headache only and non-headache sufferers), we still did not know how these symptom clusters would translate to injury recovery. Therefore, the purpose was to compare balance performance, mental status, and symptom recovery in concussed student athletes with no headache, those with posttraumatic headache, and those with characteristics of posttraumatic migraine after a sport-related concussion.

What we did in this study?

Screen Shot 2014-02-08 at 8.51.32 AMWe studied 296 patients, focusing on measures of balance (Balance Error Scoring System – click here for more on BESS test), mental status (Standardized Assessment of Concussion – click here for SAC form), and graded symptom checklist (see figure). We used the symptoms patients reported 1 day following their injury to categorize them as migraine-like sufferers, headache sufferers, or non-headache sufferers for the purposes of our analyses.

What we found and how this impacts the public?

We identified that patients were more likely to suffer from more general concussion-related symptoms (and for longer) if they endorsed migraine-like symptoms in the 24 hours within injury. We did not identify any differences in mental status or balance performance between our groups, suggesting that migraine-like sufferers may be best cared for by managing their symptoms.

Headache management and patient treatment interventions are an important aspect to concussion injury recovery. Future research should explore the implementation of pharmaceutical interventions in headache sufferers to see if this speeds up symptom resolution.

Jan 19 blog - Movement Screening ArticleEXSS Impact

Understanding the mediating role of suffering from a headache in concussion recovery is an important step to improving our understanding of the recovery and return to play process following traumatic brain injury.  Given the long term consequence of these injuries, it is important to understand these factors so that individuals are able to return to play when it is safe and at a reduced risk of injury.  In doing so we may allow individuals to remain physically active and enjoy the benefits of sport across their lifetime, thus improving overall quality of life.