Like many of the neurologists attending the annual meeting of the American Headache Society, I slipped into the hotel lobby during breaks in the program to watch World Cup soccer in bits and pieces. The images of players heading the ball caught my eye in a new way after hearing a couple of presentations about the associations between head injuries and persistent, more frequent, and disabling headaches.
The studies didn’t single out head injuries from soccer or even sports in general. But the National Electronic Injury Surveillance System gives a sense of their numbers, as reported on the American Association of Neurologic Surgeons website. Among the 351,922 sports-related head injuries treated in U.S. emergency rooms in 2008, soccer injuries ranked sixth (19,252 injuries) behind head injuries from cycling (70,802), U.S.-style football (40,825), basketball (27,583), baseball or softball (26,964), and powered recreational vehicles (25,970).
At the meeting, Dr. Sylvia Lucas of the University of Washington, Seattle and her associates reported on prospective 1-year follow-up on 377 patients after acute rehabilitation for moderate to severe traumatic brain injury. Sports or pedestrian accidents caused the injuries in 4% each, with most injuries due to vehicular accidents (56%), falls or flying objects (28%), or violence (9%).
What surprised Dr. Lucas was not just the high prevalence of headache after injury but that the prevalence held steady during the year of follow-up after discharge from rehabilitation. Compared with 18% of patients who reported having headaches before their head injury, headache prevalence was 46% soon after injury, 48% at 3 months after rehab, 44% at 6 months, and 46% at 12 months. A greater proportion of patients who reported pre-injury headaches had post-traumatic headache (48%) than did patients with no pre-injury headaches (23% with post-traumatic headache). Women were significantly more likely than men with head injury to report headaches at each time point.
Dr. Gretchen E. Tietjen of the University of Toledo, Ohio and her associates took a different approach. Surveys of 1,348 adults with migraines seen at 11 U.S. and Canadian headache centers found that the 28% of patients with a history of head or neck injury had more frequent and disabling headaches and more comorbid conditions that started at younger ages compared with patients without head and neck injuries.
Chronic headaches were a problem for 42% of the head/neck injury group and 31% of the noninjured migraineurs. Higher scores on the Headache Impact Test reflected more disabling headaches in the injured patients.
“One thing I wasn’t expecting” was the persistent difference between groups in rates of comorbidities, Dr. Tietjen said. Irritable bowel syndrome: 30% in the head/neck injury group compared with 21% in the noninjured. Fibromyalgia: 16% vs. 7%. Interstitial cystitis: 9% vs. 5%. Arthritis: 37% vs. 21%. Depression: 52% vs. 35%. Anxiety: 40% vs. 27%. Sleep apnea: 11% vs. 6%. Uterine fibroids: 17% vs. 10%.
These studies shed some light on the interplay between headache and head injury — sports-related or not — that constitutes a game-changer in ways we haven’t realized before.