Could Concussions Contribute to Chronic Headaches in Young Athletes?

Clinicians should monitor young athletes with chronic headaches.

A medical history of concussion may be a significant contributor to headache burden among adolescent and young adult athletes, according to study results published in The Journal of Headache and Pain.

Student athletes (N=7453) who had reported multiple concussions were enrolled for the study. The young athletes were evaluated at the beginning of a sport’s season by the Post-Concussion Symptom Scale (PCSS) and the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) instruments. If the students were admitted with concussion during the season, they were reassessed by the PCSS and ImPACT instruments at presentation and at 5 to 7 days. Concussions were defined as blunt trauma to the head or face causing rapid changes to mental status and/or manifestation of headaches, dizziness, nausea, vomiting, and/or blurred vision following injury. Incidence of concussion and effects of chronic headache on cognitive outcomes were evaluated.

At baseline, 1147 reported chronic headache and 6306 did not. The cohorts with and without chronic headache had a mean [SD] age of 15.3[1.5] and 15.4[1.6] years; 60.5% and 66.6% were male (P <.0001); 80.9% and 76.8% played a contact sport (P =.001); 28.8% and 21.9% played a higher-risk position in their sport (P <.0001); and 17.9% and 7.28% had a history of 2 or more concussions (P <.0001), respectively.

In the multivariate analysis, chronic headache was associated with substance use disorder (odds ratio [OR], 3.97; P =.006), depression and anxiety (OR, 2.90; P <.0001), history of concussion (OR, 2.31; P <.0001), epilepsy (OR, 2.09; P =.003), receiving special education (OR, 1.66; P =.03), playing linesman position in football (OR, 1.59; P <.0001), female gender (OR, 1.44; P <.0001), receiving speech therapy (OR, 1.29; P =.045), and missing games (OR, 1.06; P <.0001).

Our findings not only suggest the need for conservative management among youth athletes with chronic headaches, it also indicates a potential health care gap in this population…

A greater burden of headache associated with the number of past concussions (r2, 0.95) and concussions with loss of consciousness (P <.0001).

In general, the group that reported chronic headache was associated with a higher concussion incidence than those who did not (rate, 56 vs 43 per 100 patient years; P <.0001), respectively. However, after controlling for covariates, headache was not associated with incidence of concussion (adjusted OR [aOR], 0.99; P =.85).

Following a concussion injury, the students who reported chronic headaches had greater deviations from baseline to the postinjury assessment in symptom scores (mean, 1.32 vs 1.10; P =.001) and processing speed (mean, 0.44 vs 0.36; P =.02) and from baseline to the follow-up in symptom scores (mean, 0.20 vs 0.12; P =.003) and verbal memory (mean, 0.23 vs 0.18; P =.05) compared with students without chronic headaches, respectively. For other outcomes, the group with chronic headache tended to report greater deviations from baseline than those without headache.

Both groups exhibited recovery from symptoms at follow-up (P <.0001). Deviations from baseline to postinjury or follow-up assessments were associated with the presence of chronic headache (OR, 1.63; P =.0007) and female gender (OR, 1.13; P =.04).

Study limitations include having enrolled students whose concussions were not initially examined by physicians and completing the analysis retrospectively.

“Our findings not only suggest the need for conservative management among youth athletes with chronic headaches, it also indicates a potential health care gap in this population, in that those with chronic headaches may be referred for concussion diagnosis and management at lower rates than those with no such comorbidity,” the study authors wrote.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures.

This article originally appeared on Clinical Pain Advisor


Ali M, Asghar N, Hannah T, et al. A multicenter, longitudinal survey of headaches and concussions among youth athletes in the United States from 2009 to 2019. J Headache Pain. 2023;24(1):6. doi:10.1186/s10194-022-01528-3