Differentiating Concussion and Post-traumatic Headaches in Australian Rules Football-a Pilot Study

Background: Headaches are common in collision sports such as Australian Rules Football. Symptomatically, there is often significant overlap between concussion and acute post-traumatic headache syndromes. However, an accurate diagnosis is important as the management and follow-up of these two conditions differs considerably. Although neuropsychological deficits following concussion have been well documented, those following post-traumatic migraines and other forms of headache are inconsistent and poorly defined. The aim of this pilot study is to determine whether cognitive impairments are seen in footballers with post-traumatic headache syndromes and to compare any changes with those seen following concussion.Methods: 240 players were recruited from six Australian football teams (4 elite, 1 junior elite, 1 amateur) and followed prospectively over a single season. All players performed CogSport baseline testing prior to the start of the season. Players with symptoms of concussion were referred for assessment and follow-up testing. Players who were suffering from post-traumatic headache were distinguished on clinical grounds using International Headache Society criteria.Results: 20 players were referred for follow-up testing during the course of the season. Three players were identified as having suffered from post-traumatic headache syndromes. On follow-up testing with CogSport, there was no change from baseline in any of the domains tested. Conversely, concussed players demonstrated a significant deficit (50 ms) on a test of reaction time.Conclusion: this pilot study suggests that players with post-traumatic headache do not display cognitive impairments such as those observed in concussed athletes. This may be useful in distinguishing concussed players from those with post-traumatic headache syndromes and may have important implications for pharmacological and clinical management.