title: Recovery of posttraumatic migraine characteristics in patients after mild traumatic brain injury.
abstract: BACKGROUND
  Headache-related symptoms may be predictive of delayed recovery in student athletes after sport-related concussion. PURPOSE AND HYPOTHESIS: To compare balance performance, cognitive function, and symptom recovery in concussed student athletes with no headache, those with posttraumatic headache, and those with characteristics of posttraumatic migraine following a sport-related concussion. It was hypothesized that those with posttraumatic migraine would take longer to recover on all clinical measures.
  
  
  METHODS
  Cohort study (prognosis); Level of evidence, 2.
  
  
  METHODS
  A total of 296 student athletes who sustained sport-related concussions (migraine, 52; headache, 176; no headache, 68) were evaluated on measures of balance performance, cognition, and symptoms. Patients were categorized into posttraumatic migraine, posttraumatic headache, and no headache groups based on symptoms reported 1 day after injury. Serial testing was conducted with the Balance Error Scoring System, the Standardized Assessment of Concussion, and a graded symptom checklist to evaluate balance performance, cognition, and symptoms, respectively, at baseline, at the time of injury, after the event, and at days 1, 2, 3, 5, 7, and 90.
  
  
  RESULTS
  Student athletes with posttraumatic migraine experienced greater symptom severity scores than did those with posttraumatic headache and no headache at the time of injury, after the event, and through day 7 (P < .001 for all). By day 7, symptom severity scores reported by patients with posttraumatic migraine still demonstrated deficits relative to baseline (Δ = 5.6 ± 1.2) compared with patients with headache (Δ = -0.8 ± 0.7) and those with no headache (Δ = -1.4 ± 1.1). Patients with headache experienced greater symptom severity scores than patients with no headache at the time of injury (P < .001), after the event (P < .001), and at day 1 (P < .001), day 2 (P = .005), and day 3 (P = .038). Much smaller differences were observed between the headache and no headache groups beyond day 3 (P > .05). There were no group differences on balance performance (P = .439) and cognitive testing (P = .200) over time. Female patients were 2.13 times more likely than males to report posttraumatic migraine characteristics after concussion.
  
  
  CONCLUSIONS
  Posttraumatic migraine characteristics are related to prolonged symptom recovery after sport-related concussion. Clinicians should exercise caution in making decisions about return to participation for athletes with migraine-like symptoms given the increased short-term impairments and delayed symptom recovery we observed.
authors.affiliation: Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. jmihalik@email.unc.edu
authors.forename: Jason P
authors.initials: JP
authors.lastname: Mihalik
authors.forename: Johna
authors.initials: J
authors.lastname: Register-Mihalik
authors.forename: Zachary Y
authors.initials: ZY
authors.lastname: Kerr
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Marshall
authors.forename: Michael C
authors.initials: MC
authors.lastname: McCrea
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Guskiewicz
mesh_terms: D000293:Adolescent; D003071:Cognition; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D038223:Post-Concussion Syndrome / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D004856:Postural Balance; D020127:Recovery of Function; D012737:Sex Factors; D055815:Young Adult
keywords: athlete; concussion; evaluation; headache; return-to-participation