Diagnosis, prophylaxis, and treatment of headaches in the athlete.
BACKGROUND
Headaches are a common entity in the ambulatory population. Physicians involved in sports medicine must be able to accurately diagnose headaches in athletes and whether they are exacerbated by exertion. Many medications have proven or theoretical negative effects on athletic performance. Thus, we should consider all aspects of medical management and determine which therapy is least intrusive to the athlete's performance. We planned this review because of the small number of papers available on the effects of various medications on athletic performance.


METHODS
We used MEDLINE to search from 1992 to current citations, using the medical subject headings of headache, prophylaxis, treatment, review, athletes, and exercise, alone or in combination.


RESULTS
Fifty-two articles were identified and deemed appropriate for inclusion in this review.


CONCLUSIONS
Acute therapy for tension headaches in the athletic population is best done with nonsteroidal anti-inflammatory drugs. Prophylaxis of chronic, recurrent tension headaches is best accomplished by night-time tricyclic antidepressants (especially nortriptyline) or selective serotonin reuptake inhibitors. Acute therapy for athletes with migraines is best managed with sumatriptan or DHE 45 and prophylaxis can be accomplished with verapamil, antidepressants, or valproate. Exertional, cluster, and structural/infectious headaches are also discussed briefly.
Swain
R A
RA
Department of Family Medicine, School of Pharmacy, West Virginia University, Charleston, USA.
Kaplan
B
B
D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D002908:Chronic Disease; D003027:Cluster Headache / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control; D004087:Dihydroergotamine / Q000627:therapeutic use; D005260:Female; D018682:GABA Agents / Q000627:therapeutic use; D006261:Headache / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000188:drug therapy; D009661:Nortriptyline / Q000627:therapeutic use; D005082:Physical Exertion / Q000502:physiology; D011597:Psychomotor Performance / Q000187:drug effects; D012008:Recurrence; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013177:Sports / Q000502:physiology; D018170:Sumatriptan / Q000627:therapeutic use; D018781:Tension-Type Headache / Q000188:drug therapy / Q000517:prevention & control; D014635:Valproic Acid / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use; D014700:Verapamil / Q000627:therapeutic use
D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000929:Antidepressive Agents, Tricyclic; D004087:Dihydroergotamine; D018682:GABA Agents; D009661:Nortriptyline; D017366:Serotonin Receptor Agonists; D017367:Selective Serotonin Reuptake Inhibitors; D018170:Sumatriptan; D014635:Valproic Acid; D014665:Vasodilator Agents; D014700:Verapamil