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The Effects of Headache on Clinical Measures of Neurocognitive Function

Register-Mihalik, Johna MA*; Guskiewicz, Kevin M PhD*; Mann, John Douglas MD; Shields, Edgar W PhD

Clinical Journal of Sport Medicine: July 2007 - Volume 17 - Issue 4 - p 282-288
doi: 10.1097/JSM.0b013e31804ca68a
Original Research

Objective: To examine effects of preseason baseline headache and posttraumatic headache (PTH) on neurocognitive function.

Design: 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).

Setting: Clinical athletic training setting and sports medicine research laboratory.

Participants: High-school and collegiate athletes with a concussion.

Independent Variables: Preseason baseline headache, PTH, test-day.

Main Outcome Measures: 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.

From the *Department of Exercise and Sports Science, Sports Medicine Research Laboratory, University of North Carolina, Chapel Hill, North Carolina; †Department of Neurology, University of North Carolina Hospitals, Chapel Hill, North Carolina; and ‡Department of Exercise and Sports Science, University of North Carolina, Chapel Hill, North Carolina.

Submitted for publication August 28, 2006; accepted February 11, 2007.

Reprints: Johna Register Mihalik, MA, ATC, Sports Medicine Research Laboratory, University of North Carolina, CB#8700, Fetzer Gymnasium, South Road, Chapel Hill, North Carolina 27599 (e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.