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Migraines As Risk Factor for Prolonged Concussion Recovery


Here's what the medical literature says about the relationship between migraines and concussions:

  • Studies suggest that a history of pre-existing migraine headaches may be an independent risk factor for a concussion and may be associated with a prolonged recovery (1,2) 
  • A concussion can trigger a post-traumatic migraine (6) and athletes with postconcussion migraine usually have more symptoms and perform more poorly on neuropsychological tests than athletes with other types of headache or no headache at all. (1,3,4)
  • A 2011 study (5) found that  athletes without pre-existing diagnosis of migraines who developed symptoms in the migraine symptoms complex (headaches, visual problems, dizziness, noise/light sensitivity, nausea/vomiting, balance problems and numbness/tingling) in the first few days after concussion had a more prolonged recovery. 
  • Those findings were confirmed by a 2013 study (3), which found that high school football players who reported post-traumatic migraine:
    • performed significantly worse than those with headache without migraine symptoms or without headache on computerized neurocognitive tests of visual memory and reaction time, and lower on tests of verbal memory compared to the headache only group;
    • scored signficantly higher on all of 4 of the symptom factors (cognitive, somatic, emotional, sleep) throughout the course of recovery (1-7 and 8-14 days); and
    • were 7.3 and 2.6 times more likely to take 21 days or more to recover than the no headache group or headache group, respectively.
  • Several studies that focused on identifying predictors of prolonged recovery have reported that patients with higher somatic symptom scores that include migraine-like symptoms 2 or 3 days after injury were more likely to have a protracted recovery (greater than 10-14 days)(8,9,10)

Similar to mood, learning and attention disorders, it is therefore important to understand pre-injury cognitive or psychological disorders to optimize concussion management. (4,6,7)

1. Harmon K, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med 2013;47:15-26.

2. Gordon KE, Dooley JM, Wood EP. Is migraine a risk factor for the development of a concussion?  Br J Sports Med 2006;40:184-185.

3. Mihalik J, Stump J, Collins M, et al. Posttraumatic migraine characteristics in athletes following sports-related concussion. J Neurosurg 2005;102:850-855.

4. Kontos AP, Elbin RJ, Lau B, Simensky S, Freund B, French J, Collins MW. Posttraumatic Migraine as a Predictor of Recovery and Cognitive Impairment After Sport-Related Concussion. Am J Sports Med 2013;20(10). DOI:10.1177/0363546513488751 (published online ahead of print May 22, 2013)

5. Lau B, Kontos A, Collins M, et al. Which on-field signs/symptoms predict protracted recovery from sport-related concussion among high school football players?  Am J Sports Med 2011;39:2311-2318.

6. Lords Q, Greene JP. Traumatic Migraine Versus Concussion: A Case Report. Sports Health Multidisciplinary App 2013. DOI:10.1177/19417381139491701 (published online ahead of print June 26, 2013).

7. Bonfield CM, Lam S, Lin Y, Greene S. The impact of attention deficit hyperactivity disorder on recovery from mild traumatic brain injury. J Neurosurg: Pediatrics 2013. DOI:10.3171/2013/5.PEDS12424 (published online ahead of print, June 25, 2013)

8. Lau BC, Collins MW, Lovell MR. Cutoff scores in neurocognitive testing and symptom clusters that predict protracted recovery from concussions in high school athletes.  Neurosurg. 2012;70:371-379.

9. Lau BC, Collins MW, Lovell MR.  Sensitivity and specificity of subacute computerized neurocognitive testing and symptom evaluation in predicting outcomes after sport-related concussion.  Am J Sports Med. 2011;39(6):1209-1216.

10. Lau BC, Lovell MR, Collins MW, Pardini J.  Neurocognitive and symptom predictors of recovery in high school athletes. Clin J Sport Med. 2009;19(3):216-221.

Posted July 4, 2013