Sports-related headache

What Definition Is Used to Describe Second Impact Syndrome in Sports? A Systematic and Critical Review

Concern about what has been termed, "second impact syndrome" (SIS) is a major factor determining return-to-play decisions after concussion. However, definitions of SIS vary. We used Scopus to conduct a systematic review and categorize the definitions used to describe SIS. Of the 91 sources identified, 79 (87%) clearly specified that SIS involved either cerebral edema or death after a concussion when a prior concussion had not resolved. Twelve articles (13%) could be interpreted as merely the events of two consecutive concussions. Among the articles that listed mortality rates, nearly all (33/35, 94%) said the rate of death was "high" (e.g., 50% to 100%). Our review found that most articles define SIS as a syndrome requiring catastrophic brain injury after consecutive concussive episodes. Given that it is unclear how common it is to have a second concussion while not fully recovered from a first concussion, the actual mortality rate of SIS is unknown.

The Prevalence of Headache Among Athletic University Students

Background:

Headache is certainly one of the most common medical complaints of general population and one of the important causes of consumption of drugs. Despite its high overall prevalence, the epidemiology of exertional headache is not clear enough.

Objectives:

To determine the prevalence of headache in athletic and non-athletic university students and also estimating its variation between different sports fields including concussion prone sports.

Materials and Methods:

This cross-sectional study comprised 739 subjects (367 athletes and 372 non-athletes). The present study was carried out on athletic and non-athletic university students aging between 18 to 28 years. An athlete was defined as a person who had at least one year of experience in sports including football, volleyball, basketball, wrestling, boxing, martial arts, track and field, chess, handball and swimming for three sessions a week each lasting at least 2 hours. The random selection of these participants was done by an independent statistical consultant. A questionnaire was used for data collection which was then analyzed by statistical methods.

Results:

Our study comprised 739 subjects (367 athletes and 372 non-athletes). Among athletic university students, 152 (41.2%) participants complained of headache. Such a complaint was present in 217 (58.3%) non-athletic university students. This lower prevalence of headache in athletes was statistically significant (P value < 0.001). Among ten different sports fields, the prevalence of headache among wrestlers was significantly higher than others (P value < 0.001).

Conclusions:

The prevalence of headache is seemingly lower in athletic university students than non-athletic ones. In addition, among athletes, those who are participating in concussion prone sports especially wrestling experience headache more than athletes of other fields.

Relationship between the apolipoprotein E gene and headache following sports-related concussion

INTRODUCTION

Headache is one of the most commonly reported and longest lasting symptoms that concussed athletes report, yet the etiology of headache symptoms following concussion is not entirely clear. The purpose of this study was to determine whether the e4 allele of the apolipoprotein E (APOE) gene influences the presence and severity of postconcussion headache.

METHOD

Participants were composed of 45 concussed athletes and 43 healthy/nonconcussed athletes who were involved in a clinically based sports concussion management program. All athletes completed the Post-Concussion Symptom Scale (PCSS). The "headache" symptom from the PCSS was the primary outcome variable. Buccal samples were collected and analyzed to determine APOE genotype.

RESULTS

A significantly greater proportion of concussed e4+ athletes than e4- athletes endorsed headache. Furthermore, concussed e4+ athletes endorsed more severe headaches than e4- athletes. When examining the healthy/nonconcussed sample (i.e., athletes at baseline), results showed no differences between e4 allele groups with respect to the presence and severity of headache.

CONCLUSIONS

These findings show that when compared to concussed e4- athletes, e4+ athletes are more likely to (a) endorse postconcussion headache and (b) report more severe headache symptoms following concussion. Conversely, it appears that the e4 allele does not influence baseline reports of headache. Thus, results suggest that those with the e4 genotype may be at a higher risk for experiencing headache-related difficulties only after a concussion is sustained.

Aerobic Exercise for Reducing Migraine Burden: Mechanisms, Markers, and Models of Change Processes

BACKGROUND

Engagement in regular exercise routinely is recommended as an intervention for managing and preventing migraine, and yet empirical support is far from definitive. We possess at best a weak understanding of how aerobic exercise and resulting change in aerobic capacity influence migraine, let alone the optimal parameters for exercise regimens as migraine therapy (eg, who will benefit, when to prescribe, optimal types, and doses/intensities of exercise, level of anticipated benefit). These fundamental knowledge gaps critically limit our capacity to deploy exercise as an intervention for migraine.

OVERVIEW

Clear articulation of the markers and mechanisms through which aerobic exercise confers benefits for migraine would prove invaluable and could yield insights on migraine pathophysiology. Neurovascular and neuroinflammatory pathways, including an effect on obesity or adiposity, are obvious candidates for study given their role both in migraine as well as the changes known to accrue with regular exercise. In addition to these biological pathways, improvements in aerobic fitness and migraine alike also are mediated by changes in psychological and sociocognitive factors. Indeed a number of specific mechanisms and pathways likely are operational in the relationship between exercise and migraine improvement, and it remains to be established whether these pathways operate in parallel or synergistically. As heuristics that might conceptually benefit our research programs here forward, we: (1) provide an extensive listing of potential mechanisms and markers that could account for the effects of aerobic exercise on migraine and are worthy of empirical exploration and (2) present two exemplar conceptual models depicting pathways through which exercise may serve to reduce the burden of migraine.

CONCLUSION

Should the promise of aerobic exercise as a feasible and effective migraine therapy be realized, this line of endeavor stands to benefit migraineurs (including the many who presently remain suboptimally treated) by providing a new therapeutic avenue as an alternative or augmentative compliment to established interventions for migraine.

Migraine headache confounding the diagnosis of acute mountain sickness

A 36-year-old man with a history of migraine headache attempted to hike from Lukla, Nepal, to Mount Everest Base Camp. On the sixth day of hiking, he had a migraine headache. After achieving resolution with typical therapies and rest, he ascended higher. Another headache developed that was interpreted to be a migraine. The headache was treated, and he ascended higher, after which severe symptoms of acute mountain sickness developed, necessitating his evacuation by helicopter. Persons with headaches in daily life may present challenges to diagnosis when traveling to high altitude. Careful evaluation and decision making are needed to achieve proper diagnosis and treatment of acute mountain sickness.

Presence of headache does not influence sideline neurostatus or balance in high school football athletes

OBJECTIVE

Headache is the primary self-reported symptom used to indicate concussion. Thus, we examined the relationship between reports of nonconcussion-induced headache after contact sport participation and scores on common concussion assessment measures.

DESIGN

Two-group repeated measures. SETTIN:: Secondary school.

PARTICIPANTS

One hundred five athletes from 3 area football teams completed a baseline evaluation. Sixteen athletes reported headaches after a practice/game and were compared with 16 gender-matched, age-matched, height-matched, weight-matched, and position-matched controls.

INDEPENDENT VARIABLE

Self-report headache.

MAIN OUTCOME MEASURES

Symptom severity and endorsement reported on the Graded Symptoms Checklist (GSC), neurostatus measured using the Standard Assessment of Concussion (SAC), and postural control evaluated with the Balance Error Scoring System (BESS).

RESULTS

Total symptom severity significantly increased (P < 0.01; 8.06 ± 2.22 to 16.06 ± 3.82) in the headache group and significantly decreased in the nonheadache group (P = 0.01; 6.81 ± 1.85 to 3.00 ± 1.08). Symptom endorsement increased in the headache group (P = 0.06; 3.25 ± 0.80 to 5.25 ± 1.08) and significantly decreased in the nonheadache group (P = 0.01; 3.19 ± 0.78 to 1.69 ± 0.58). Both groups showed nonsignificant (P > 0.05) changes in SAC scores (headache, 24.75 ± 0.73 to 24.81 ± 0.75; nonheadache, 24.50 ± 0.73 to 24.87 ± 1.20). Errors of the BESS significantly increased in both the groups at postgame/postpractice evaluation (headache, P = 0.01; 14.94 ± 1.86 to 20.31 ± 2.23; nonheadache, P < 0.01; 13.31 ± 1.68 to 18.13 ± 1.69). The presence of headache was significantly correlated with symptom reports (P > 0.05) but not SAC or BESS performance.

CONCLUSIONS

These findings indicate that the use of headache, exclusively or in combination with other concussion-related symptoms, does not indicate performance on common concussion tools. This supports previous works, suggesting that clinicians must adopt a multifaceted approach to concussion assessment.

Headaches Amongst Pool Players

BACKGROUND

Pool-players' headache is a newly described entity. We studied the prevalence and risk factors for the development of headaches amongst pool players.

METHODS

We obtained demographic information, history of pre-existing headaches, frequency and duration of pool-playing, history of pre-existing headaches and their subtypes, competitive pool-playing and worsening or development of headaches amongst pool-players at 2 pool centers. Univariate and multivariate analyses were performed and statistical significance was set at P < .05.

RESULTS

Two hundred and three players, of mean age 22.6 (SD 7.7 years), participated in this study. Of the 21 respondents who reported headaches when playing pool, 11 (52.4%) had pre-existing headaches and 10 (47.6%) had no pre-existing headaches. Age and history of pre-existing headaches were significantly associated with worsening of headaches.

CONCLUSION

Pool-players are susceptible to the development of headaches. Avoidance and reduction in the frequency of pool-playing may reduce the frequency of headaches amongst pool players.