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Presence of Headache Does Not Influence Sideline Neurostatus or Balance in High School Football Athletes

Sabin, Matthew J PhD*; Van Boxtel, Bridget A MS; Nohren, Matthew W MS; Broglio, Steven P PhD§

Clinical Journal of Sport Medicine: September 2011 - Volume 21 - Issue 5 - p 411-415
doi: 10.1097/JSM.0b013e318223f3a4
Original Research

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.

Design: Two-group repeated measures.

Setting: Secondary school.

Participants: 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.

Independent Variable: Self-report headache.

Main Outcome Measures: 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.

From the *Department of Exercise and Sport Science, Eastern Kentucky University, Richmond, Kentucky; †Steadman Clinic, Vail, Colorado; ‡ATI Physical Therapy, Chicago, Illinois; and §Neurotrauma Research Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan.

Submitted for publication November 9, 2010; accepted May 11, 2011.

The authors report no conflicts of interest.

Corresponding Author: Matthew J. Sabin, PhD, Department of Exercise and Sport Sciences, Eastern Kentucky University, Moberly Bldg, Room 231, 521 Lancaster Ave, Richmond, KY 40475 (

© 2011 Lippincott Williams & Wilkins, Inc.