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Headaches a Warning Sign for High School Athletes

Players often return to sports too soon after concussion, study finds

FRIDAY, March 28, 2003 (HealthDayNews) -- Don't dismiss headaches among high school athletes who suffer concussions.

Doing so -- and letting the athletes return to play too soon -- could lead to much more serious, perhaps even permanent, brain damage, say University of Pittsburgh Medical Center researchers.

"If someone who suffers a sports-related concussion has a post-concussion headache -- just a headache -- they probably should not return to play until they've had a more detailed neuro-cognitive evaluation," says Dr. Melvin Field, co-author of the Pittsburgh study on concussions among high school athletes.

"Headache with concussion can be serious," adds Field, chief resident in the Department of Neurological Surgery at Pittsburgh. "It's not just because you had your bell rung that you have a headache. It is your brain telling you that it hasn't recovered from its injury yet."

That message goes unheeded far too often in high school sports, says the study, reported in the March-April issue of the American Journal of Sports Medicine.

Multiple concussions can lead to permanent damage that reduces some brain functions. In rare cases, high school athletes who suffer a concussion before recovering from an earlier one can suffer "second-impact syndrome," which has resulted in at least 20 deaths to date, Field says.

Field explains that most coaches, team trainers and primary-care physicians rely on traditional concussion scales to measure concussion severity -- and to determine when players should return to contact sports.

Most of these scales, however, base recommendations on an athlete's return to play on the presence and duration of loss of consciousness, amnesia and neurological abnormalities identified at the time of injury, the researchers say. Few of the scales include headache as a criterion for determining the concussion's severity, even though athletes who had headaches a week after suffering sports-related concussions usually had not fully recovered, the researchers say.

The Pitt researchers reviewed the cases of 109 high school athletes who had concussions in the 2000-2001 school year. Most of the athletes were male football players, but the study also included female players and other sports such as basketball, soccer, hockey and lacrosse.

Of the 109 athletes, 36 reported headaches -- 14 mild and 22 moderate to severe -- a week after concussions and 73 did not.

All the athletes with headaches a week after concussions performed significantly worse than those without headaches on a computerized test measuring neuro-cognitive functions such as reaction time, memory, attention, and speed of processing information, the study found.

Poor performance on the test is a clear sign concussions have not healed, the study says, making the athletes vulnerable to more serious concussions if they return to play.

Each year, Pitt researchers say, an estimated 63,000 high school athletes suffer concussions, in which the brain is rocked back and forth inside the skull because of a blow to the head or upper body. Other symptoms of concussions include disorientation, confusion, dizziness, amnesia and uncoordinated hand-eye movements.

"Probably 90 to 95 percent of all team physicians and trainers and primary-care physicians will use concussion scales to determine when athletes should return to play," Field says. "And this data suggests that athletes who suffer mild concussions with persistent headache will often have neurological abnormalities ... despite the fact that many grading scales would allow the athlete to return to play."

To measure neuro-cognitive function, the researchers used a 20-minute computer assessment called ImPACT, Immediate Post-concussion Assessment and Cognitive Testing. About 250 schools nationwide now use ImPACT to evaluate the effects of concussion and help determine when it's safe for an athlete to return to play, the researchers say.

Dr. Gerard Varlotta, director of sports rehabilitation at the Rusk Institute of Rehabilitation Medicine at New York University Medical Center, says the Pitt study highlights the importance of taking post-concussion headaches seriously.

"In the past, we used to think a minor headache was not a major issue; after a concussion, there's no such thing as a minor headache," says Varlotta, an associate professor in rehabilitation medicine at the NYU School of Medicine.

Varlotta calls the study "very, very important" in part because it shows the importance of neurological testing to help determine the severity of a concussion, even in the absence of other symptoms.

If tests reveal neurological impairment in an athlete who has had a concussion, Varlotta says, "he has a significantly increased risk of having another injury which leaves him with further, permanent neurological impairment."

More information

For more on sports-related concussions, visit the University of Pittsburgh. To learn about signs of a concussion, check with the American Academy of Family Physicians.

SOURCES: Melvin Field, M.D., chief resident, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh; Gerard Varlotta, D.O., director, sports rehabilitation, Rusk Institute of Rehabilitation Medicine, New York University Medical Center, and associate professor, rehabilitation medicine, New York University School of Medicine, both in New York City; March-April 2003 American Journal of Sports Medicine
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