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Abstract & Commentary
Synopsis: Those athletes with persistent headache beyond 7 days postconcussion likely have not sufficiently recovered given worse neurocognitive testing, slower reaction times, and reduced memory performance.
Source: Collins MW, et al. Relationship between post-concussion headache and neuropsychological test performance in high school athletes. Am J Sports Med. 2003;31(2):168-173.
Many high school athletes receive concussions during their sporting events. The significance of a high school athlete having a persistent headache after a sports-related concussion is not well studied. Many grading systems and return-to-play parameters exist. This study was designed to determine if athletes sustaining a concussion and reporting a headache at 7 days post injury differed from a group of athletes sustaining a concussion but with headache cleared by the seventh day.
This is a prospective study of 109 high school athletes who had sustained a concussion and who were divided into 2 groups: those reporting headache 7 days after injury and those reporting no headaches. The 2 groups were compared by an on-field exam and cognitive tests approximately 7 days after injury. The results showed that athletes reporting a post-traumatic headache 7 days after the concussion demonstrated significantly worse performance on reaction time and memory cognitive scores. Additionally, these athletes reported more concussion symptoms other than headache and were more likely to have demonstrated on-field anterograde amnesia.
Collins and colleagues concluded that high school athletes reporting a postconcussion headache 7 days after injury are likely to have an incomplete recovery after concussion.
Comment by James R. Slauterbeck, MD
So what are these kids, coaches, and parents doing? Are all the aforementioned "players" and injured athletes informed about the potential repercussions of a lingering concussion as evidence by postconcussion headaches and other symptoms? How many Muhammad Alis do we need to see before we open our eyes and realize the potential additive injury of rising from the 10 count just in time to be knocked down again? How many concussions should our youth sustain before it is unsafe to return to play contact sports? So many questions . . . So few answers!
This is good article from a respected group identifying effects of a concussion that may be far more significant than originally perceived. Those athletes with a moderate-to-severe headache 7 days postinjury had worse neurocognitive function than others. Any athlete with a headache at day 7 had more postconcussive symptoms and demonstrated significantly slower reaction times and reduced memory performance on testing.
Many athletes show up to Saturday morning injury clinic with a headache after a playing in the game and receiving a head blow. Some rules are more liberal at returning to play, and other guidelines require waiting 7 days after the headaches are gone. None of the widely used guidelines use neuropsychological testing to help determine when an athlete should return to sport. Maybe we need to create and validate a simple test to administer preseason and compare to postconcussion to help determine when one is ready to return to sport.
All in all, I think it is important to respect the postconcussion headache. It is probably best to err on the side of conservatism when one determines the best time to safely return a postconcussion high school athlete to play when they have a persistent headache at 7 days. Many more studies need to be initiated with pre- and postneuropsychological testing to better determine the short- and long-term effects of concussions and to determine when cognitive function returns to normal.
Dr. Slaughterbeck, Associate Professor, Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, is Associate Editor of Sports Medicine Reports.