How common is migraine in college athletes?

Recently, there has been a lot of attention focused on research and media on concussion, its effects on the brain and symptoms that patients experience.  Awareness of this concern and the symptoms athletes may experience has increased.  However, little is still known about the spectrum of headache disorders in collegiate student-athletes, especially non-traumatic headaches.  Many primary headache disorders (migraine, etc.) have been reported to be exacerbated by exercise.  Headache is also the most common symptom following head trauma and occurs in up to 93% of individuals after concussion.  Headaches reported by an athlete following a concussion can further complicate decisions made by clinicians, team physicians, or physical trainers about safe return to play (RTP); as it can be unclear whether an athlete has headaches related to an exacerbation of a primary headache disorder, new onset headache unrelated to trauma, or is in the recovery phase following concussion.

Dr. Tad Seifert and several other collaborators designed a study to learn more about the prevalence of headache in this special population.  They published there results in Headache Journal titled “Comprehensive Headache Experience in Collegiate Student-Athletes: An Initial Report from the NCAA Headache Task Force.”  Relying on four NCAA participating programs, 834 student-athletes completed a 20 question questionnaire looking at personal and family history of headache, disability associated with pain, as well as concussion history.  This study included both male and female athletes in a variety of Division-I sports, with differing degrees of contact exposure.

The study found a prevalence of migraine of 23.7% (n = 198) which compared to the general population prevalence of 16% appears high, but may also reflect typical prevalence seen in young adults as one study reported a prevalence in this age group of 23%.  The study has a limitation in that the type of headache diagnosis relied on the athlete’s response rather than a clinician’s diagnosis, and may be an over/under representation of headaches that meet ICHD-III criteria.  Additionally, 25.2% (n = 210) of responders reported a history of sinus headache.  It has been reported in the past that sinus headaches have often been a misdiagnosis of migraine, suggesting the overall prevalence in this study may have been higher than 23.7%.

Deciding on the most appropriate return to play guidelines following a concussion continues to be a challenge, and this is especially amplified at a higher level of play.  Diagnoses of migraine or other primary headache disorders may increasingly become an important part of an athlete’s baseline assessment.

HEADACHE JOURNAL https://onlinelibrary.wiley.com/doi/10.1111/head.13104/full