Migraine precipitated by head trauma in athletes

Three members of a university football team were evaluated because of migraine symptoms precipitated by head trauma. Analysis of the clinical data from these cases, as well as eight previously reported in athletes, reveals that the head trauma is usually minor and not associated with amnesia; and, after a symptom-free interval most often of several minutes, visual, motor, sensory, or brainstem signs and symptoms begin. These usually last for approximately 15 to 30 min and are followed by headache frequently accompanied by nausea and vomiting. In 9 of 11 cases, attacks have occurred with subsequent head trauma. Only 4 of the 11 athletes admitted to spontaneous episodes, however, the incidence may be higher since they have not been followed by a sufficient period of time. Prophylaxis with antimigrainous drugs does not appear to be indicated. The decision as to future participation in contact sports is based primarily on the results of a thorough neurologic evaluation. The possible long-term sequela of this apparent "benign" condition, particularly in those athletes with repeated episodes, is not known since the entity has only recently been recognized. A migraine attack occurring in the course of an athletic event, particularly contact sports, can simulate a serious neurologic emergency. Despite its frequency in the general population and a propensity for onset in the first three decades of life, migraine has not been appreciated in the past as a possible significant sports medicine problem.