title: The effects of headache on clinical measures of neurocognitive function.
abstract: OBJECTIVE
  To examine effects of preseason baseline headache and posttraumatic headache (PTH) on neurocognitive function.
  
  
  METHODS
  Retrospective repeated measures study with headache groups formed regarding baseline headache score (0 = negative headache; 1-6 = positive headache) and day 1 postinjury headache score (0 = no headache; 1-2 = mild headache; 3-6 = moderate-severe headache).
  
  
  METHODS
  Clinical athletic training setting and sports medicine research laboratory.
  
  
  METHODS
  High-school and collegiate athletes with a concussion.
  
  
  METHODS
  Preseason baseline headache, PTH, test-day.
  
  
  METHODS
  A Graded Symptom Checklist (GSC) was used to assess symptoms. The Automated Neuropsychological Assessment Metrics (ANAM) and the Standardized Assessment of Concussion (SAC) were used to assess neuropsychological function and mental status. The Balance Error Scoring System (BESS) was used to assess postural stability.
  
  
  RESULTS
  Both baseline headache groups displayed a higher symptom endorsement and higher symptom severity at day 1 postinjury and improved by day 7 postinjury. The positive headache group reported an even greater increase in symptom severity and presence (P < 0.05). ANAM revealed deficits in both groups 1 day postinjury. All PTH headache groups displayed a difference in symptom number and severity with the increase being magnified by headache severity (P < 0.05). Individuals reporting moderate-severe PTH displayed increased deficits subacutely but improved by 5-7 days postinjury on overall neuropsychological performance, reaction time, and working memory (P < 0.05). Deficits were observed for all ANAM measures except simple reaction time 1 (SRT 1) and match to sample subacutely and improved over time (P < 0.05). The SAC yielded an interaction (P < 0.05) for baseline headache. The BESS yielded no significant findings.
  
  
  CONCLUSIONS
  Clinicians should consider headache when assessing concussion and during preseason baseline assessments because headache may affect symptom presence and other clinical measures of concussion.
authors.affiliation: Department of Exercise and Sports Science, Sports Medicine Research Laboratory, University of North Carolina, Chapel Hill, North Carolina 27599, USA. johnakay@email.unc.edu
authors.forename: Johna
authors.initials: J
authors.lastname: Register-Mihalik
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Guskiewicz
authors.forename: John Douglas
authors.initials: JD
authors.lastname: Mann
authors.forename: Edgar W
authors.initials: EW
authors.lastname: Shields
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries; D001924:Brain Concussion / Q000150:complications / Q000503:physiopathology; D003072:Cognition Disorders / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D051298:Post-Traumatic Headache / Q000523:psychology*; D012189:Retrospective Studies; D013177:Sports; D013178:Sports Medicine; D011795:Surveys and Questionnaires; D014481:United States