title: Presence of headache does not influence sideline neurostatus or balance in high school football athletes.
abstract: 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.
  
  
  METHODS
  Two-group repeated measures. SETTIN:: Secondary school.
  
  
  METHODS
  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.
  
  
  METHODS
  Self-report headache.
  
  
  METHODS
  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.
authors.affiliation: Department of Exercise and Sport Science, Eastern Kentucky University, Richmond, Kentucky 40475, USA. mnmsabin@yahoo.com
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Sabin
authors.forename: Bridget A
authors.initials: BA
authors.lastname: Van Boxtel
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Nohren
authors.forename: Steven P
authors.initials: SP
authors.lastname: Broglio
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D001924:Brain Concussion / Q000150:complications / Q000175:diagnosis*; D005538:Football / Q000293:injuries*; D006261:Headache / Q000209:etiology*; D006801:Humans; D008297:Male; D009460:Neurologic Examination; D004856:Postural Balance; D012720:Severity of Illness Index