Relationship between postconcussion headache and neuropsychological test performance in high school athletes

Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15203, USA.
The American Journal of Sports Medicine (Impact Factor: 4.36). 03/2003; 31(2):168-73. DOI: 10.1177/03635465030310020301
Source: PubMed


The relevance of headache to outcome after sports-related concussion is poorly understood.
High school athletes reporting headache approximately 1 week after injury will have significantly more other concussion symptoms and will perform more poorly on neuropsychological tests than athletes not experiencing headache.
Prospective cohort study.
Study participants included 109 high school athletes who had sustained concussion and who were divided into two groups: those reporting headache 7 days after injury and those reporting no headaches. The two groups were compared regarding on-field markers of concussion severity at the time of injury and symptoms and neurocognitive test results collected via ImPACT, a computerized neuropsychological test battery and postconcussion symptom scale, at a mean of 6.8 days after injury.
Athletes reporting posttraumatic headache demonstrated significantly worse performance on reaction time and memory ImPACT neurocognitive composite scores. These athletes also reported significantly more symptoms other than headache and were more likely to have demonstrated on-field anterograde amnesia.
Findings suggest that any degree of postconcussion headache in high school athletes 7 days after injury is likely associated with an incomplete recovery after concussion.

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Available from: Mark R Lovell
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    • "The perception of sports concussions has undergone a gradual overhaul throughout the past decade where an injury that was once considered to be inconsequential has come to be understood within the neuropsychological and medical communities to be an injury with quantifiable changes to the brain that are both transient [1-3] and persistent [4-7]. According to the current literature, transient changes are by far more abundant as most of these occur within the acute phase where athletes exhibit neurocognitive changes [8-10] in addition to neurophysiological alterations [11-15]. Persistent changes have also been documented [4-7,16-19], though some doubt their clinical legitimacy, citing litigation and other secondary gains as confounds [20-23]. "
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    ABSTRACT: Despite negative neuroimaging findings many athletes display neurophysiological alterations and post-concussion symptoms that may be attributable to neurometabolic alterations. The present study investigated the effects of sports concussion on brain metabolism using 1H-MR Spectroscopy by comparing a group of 10 non-concussed athletes with a group of 10 concussed athletes of the same age (mean: 22.5 years) and education (mean: 16 years) within both the acute and chronic post-injury phases. All athletes were scanned 1-6 days post-concussion and again 6-months later in a 3T Siemens MRI. Concussed athletes demonstrated neurometabolic impairment in prefrontal and motor (M1) cortices in the acute phase where NAA:Cr levels remained depressed relative to controls. There was some recovery observed in the chronic phase where Glu:Cr levels returned to those of control athletes; however, there was a pathological increase of m-I:Cr levels in M1 that was only present in the chronic phase. These results confirm cortical neurometabolic changes in the acute post-concussion phase as well as recovery and continued metabolic abnormalities in the chronic phase. The results indicate that complex pathophysiological processes differ depending on the post-injury phase and the neurometabolite in question.
    Full-text · Article · Aug 2011 · BMC Neurology
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    • "Toward that end, ImPACT has been used in multiple studies of athletes with concussions. The composite scores, especially the memory and symptoms composites from Version 1 (Collins et al., 2003; Iverson et al., in press; Lovell et al., 2003; Lovell et al., in press) and the Verbal Memory, Reaction Time, and symptoms composites from Version 2 (Iverson et al., 2004), are very sensitive to the initial effects of concussion in amateur athletes. "
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    ABSTRACT: The purpose of this study was to examine the validity of ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing), a computerized neuropsychological test battery, for measuring attention and processing speed in athletes with concussions. This was accomplished by comparing the computerized testing to a traditional neuropsychological measure, the Symbol Digit Modalities Test (SDMT). Participants were 72 amateur athletes who were seen within 21 days of sustaining a sports-related concussion (Mean = 9.4, SD = 5.4 days). As predicted, the SDMT correlated more highly with the Processing Speed and Reaction Time composites than the Verbal Memory and Visual Memory Composites from ImPACT. The composite scores from ImPACT and the SDMT were subjected to exploratory factor analysis, revealing a two-factor solution interpreted as Speed/Reaction Time and Memory. It appears as if the Processing Speed Composite, Reaction Time Composite, and SDMT are measuring a similar underlying construct in this sample of concussed amateur athletes.
    Full-text · Article · Sep 2005 · Journal of Clinical and Experimental Neuropsychology
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    • "It was beyond the scope of this paper to systematically analyze every symptom in this manner. However, this same methodology recently was used to study the relation between headache and neuropsychological outcome in concussed amateur athletes (Collins et al., 2003). That is, 73 concussed athletes with no reported headaches at approximately 7 days post injury were compared to 36 athletes who had reported headaches at this post-injury interval. "
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    ABSTRACT: The purpose of this study was to examine the relation between the subjective report of feeling foggy at one-week post concussion and acute neuropsychological outcome. The outcome variables were derived from a computerized neuropsychological screening battery, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). Participants were 110 high school students who sustained a sports-related concussion and were evaluated 5-10 days post injury (M = 6.8 days). Athletes were divided into two groups on the basis of self-reported fogginess. The first group reported no fogginess (n = 91), whereas the second group reported experiencing some degree of fogginess (n = 19) on a 6-point scale. The athletes with persistent fogginess experienced a large number of other post-concussion symptoms, compared to the athletes with no reported fogginess. In addition, the athletes with persistent fogginess had significantly slower reaction times, reduced memory performance, and slower processing speed. Thus, athletes with any degree of self-reported fogginess at one-week post injury are likely to have adverse effects from their concussions in multiple domains.
    Full-text · Article · Nov 2004 · Journal of the International Neuropsychological Society
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