Athletes particularly susceptible to migraine headaches

Approximately 38 million Americans suffer from migraine headaches. These episodes often interfere with work and social activities. Athletes are not immune from this disabling condition.

Migraine headaches are best defined as throbbing headaches that last from four to 72 hours, often accompanied by additional symptoms including nausea, vomiting, visual disturbances, light sensitivity and sensitivity to sound.

These headaches may be preceded by periods of neurologic impairment lasting approximately 30 minutes before the actual pain begins. These symptoms are often referred to as an aura and may include loss of vision, weakness and numbness on one side of the body and difficulty with speech. Due to the nature of these symptoms, the episodes can be confused with the onset of a stroke. 

Changes in sleep schedule, diet, frequent travel or changes in climate can trigger a migraine, making athletes particularly susceptible. Contact sport athletes face the additional complication of head trauma.

Headaches can develop with exertion, independent of head trauma. These headaches typically last from five minutes to 24 hours. Head trauma can precipitate a migraine in a migraine-prone individual. The onset of any headache during competition in a contact sport can create confusion with whether it is contact-related and necessitates removal from a contest and a prolonged return-to-play protocol. 

Treatment of migraine headaches in athletes can involve symptomatic treatment with medications taken at the onset of headache or preventive treatment with medications taken on a regular schedule. Unfortunately, the list of medications that can be used in athletes is limited by effects they may have on performance.

“Headache is well known to have serious effects on productivity. Absenteeism and even "presenteeism" (showing up for work but being far less productive) may have far greater implications for athletes than in the general population,” reports Dr. Vernon Williams, Director of Sports Neurology at the Kerman-Jobe Clinic. “The culture of competition and athletics typically doesn't tolerate headache as an acceptable excuse or explanation for poor athletic performance.”

Adequate evaluation and treatment of headaches can improve enjoyment and performance for athletes at all levels.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Insulin pumps becoming popular among diabetic athletes

Diabetes affects more than 29 million people in the United States. Often the most effective treatments consist of a combination of insulin, diet and exercise. Ironically, achieving a balance between insulin and exercise can often be a challenge, especially for high-level athletes.

Diabetes is classified as type 1 or type 2 based on the body’s response to insulin, a hormone produced in the pancreas. Insulin enters the bloodstream in response to variations in the blood glucose level. Insulin allows glucose to enter cells and produce energy.

Type 1 diabetes occurs when the pancreas can't produce enough insulin. It is typically identified in childhood or adolescence but can be seen at any age.

Type 2 diabetes occurs when the body becomes resistant to the insulin available or the pancreas cannot produce enough insulin to keep up with demand. This type is usually seen in adults who have become obese. Unfortunately, it is now being seen more often in adolescents.

The goal of diabetes treatment is to create balance in the blood glucose level. This is done by decreasing the intake of glucose, burning more glucose through exercise, increasing the sensitivity of cells to insulin and the administration of insulin by injection. Often a combination of these strategies is applied.

Any attempt to properly regulate blood glucose levels in diabetes requires daily planning, especially for athletes. Insulin pumps are becoming increasingly popular.

Insulin pumps are wireless devices that can be programmed to infuse insulin via a small tube placed under the skin. Athletes can adjust the rate based on their level of activity even during a long-distance event.

"The use of insulin pumps in athletes is a convenient and efficient way to deliver insulin to the body that more closely mimics the way insulin is produced in a normal pancreas,” states Dr. Deena Casiero, Head Team Physician at UConn. “Insulin pumps also tend to lead to more well-controlled blood sugars overall, which is important for any athlete.”

Hopefully, the use of insulin pumps encourages more diabetics to participate in sports at a high level. 

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Post-concussion syndrome keeping NHL star, Sidney Crosby, off ice

Sidney Crosby recently reported having suffered his third concussion to the Pittsburgh Penguins medical staff. As a result, he missed the first game of the season and remains on injured reserve. His admission has raised many questions regarding his future in the NHL.

Concussion was first described in writings by the ancient Greeks. It is best described as a group of neurologic symptoms that result from a biomechanical force applied to the brain. Although a great deal has been learned regarding the recognition of a concussion, there is no specific diagnostic test and no definitive treatment.

Millions of sports-related concussions are reported each year, the vast majority of which resolve over a period of days. The persistence of symptoms has been described as post-concussion syndrome (PCS).

Among the symptoms for PCS are headache, depression, fatigue, disordered sleep and poor memory. These symptoms are often considered part of the original injury and delay a return to athletics. In fact, specifically treating these conditions can allow for a safe return and avoid an extended absence from academics and sports.

Chronic Traumatic Encephalopathy (CTE) has recently become a fear among athletes who have suffered multiple concussions. The potential for developing violent behavior, depression and suicide has prompted early retirement from contact sports. It is important to note that CTE is only diagnosed post-mortem.

In their recently published book, “Back In The Game: Why Concussion Doesn’t Have to End Your Athletic Career,” Dr. Jeffrey Kutcher and Ms. Joanne Gerstner clarify much of the confusion surrounding the diagnosis and treatment of concussion. This is an authoritative text written in understandable terms. It is highly recommended for parents, athletes and coaches.

Sid Crosby’s potential return will be determined by his ability to increase activity without disabling symptoms. Most importantly, his injury was self-reported and that reflects some success in the area of education and awareness of concussion.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Careful judgment key when dealing with opiates

Opiate medications have been the basis for pain relief over thousands of years. Unfortunately, inappropriate use has lead to an addiction crisis affecting many people, including high-level athletes.

Opium is an extract from the seedpods of the poppy plant most commonly grown in middle and far eastern countries. The most active substance in opium is morphine. Currently, a variety of oral opiates have successfully alleviated pain but in some cases lead to lifelong addiction.

Opiates work by binding to receptors on nerve cell membranes in the brain. This action blocks the proliferation of neurotransmitters that cause pain. Over time, increasing doses of opiates are required to achieve pain relief. Unfortunately, this can lead to addiction and the search for alternative illegal narcotics.

There are very few industries where one hundred percent of your employees will suffer a work-related injury. Professional sports are among those industries. High-velocity collision sports and combat sports athletes are particularly vulnerable.

Injuries move through acute and chronic phases. Acute injuries last days to weeks while chronic injuries last months to years. Many of the injuries seen in sports also require surgical intervention necessitating post-operative pain relief.

“Opiates play a helpful role in pain control immediately following acute injury and postoperatively,” states Dr. Jeffrey Anderson, Medical Director of UConn Student Health Services. “They don’t have a legitimate role in the management of chronic pain in the competitive athlete.”

Fortunately, there are many effective, non-addicting, medications designed for chronic pain. Many of these medications typically act on the brain for other conditions including epilepsy and depression. 

The use of opiate analgesic medications must be offset by careful judgment and consideration of alternative medications.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Initiative aims to curb sports misconduct

Organized sports are a big factor in promoting better physical and mental health, higher grades and better social relationships among athletes. Unfortunately, it is estimated that one out of eight athletes under the age of 18 will be abused or assaulted.

The Safe Sport Initiative is the response of the Olympic community to recognize, reduce and respond to misconduct in sports at every level. Six primary forms of misconduct have been described. They include bullying, harassment and hazing as well as emotional, physical and sexual misconduct. 

Hazing and other rituals have long been a part of sports. More recently these rituals have sometimes taken on a more violent, destructive and sexual nature. Coaches and staff must be aware of any hazing practices and be sure that all athletes are adequately protected.

Bullying and harassment are typically directed to athletes who are different. Bullies target all athletes and their actions are often easily mistaken for good-natured teasing. Harassment is more offensive and often linked to discrimination. Targets of harassment are often different based on race, religion or sexual orientation. Sexual harassment has become pervasive in athletics. Some estimates report 57 percent of athletes have been sexually harassed. Both of these behaviors can be detrimental to the performance of a team as a whole.

Trust and power are the essential elements of the coach-athlete relationship. This relationship involves a delicate balance between encouragement and discipline that can easily be misused to an athlete’s detriment.

Grooming is the process where a coach or other potential abuser establishes sufficient trust with the athlete and parents that allows for an opportunity for abuse. Coaches can also establish what an athlete values most and use that as currency for abuse.

Child abuse is among the most heinous crimes. It is only through education and vigilance that it can be stopped.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Cupping therapy used by Michael Phelps is effective treatment


Ancient medical practices have been rediscovered by modern day athletes as potential tools to speed injury recovery. Among these is the practice of cupping that was recently in the headlines because of its adoption by the most decorated Olympic athlete, Michael Phelps.

Cupping therapy involves placing of cups that are made of a variety of materials over affected areas. These cups are then used to create a suction that draws increased circulation to the region. The goal is to diminish inflammation, reduce pain and provide relaxation through deep tissue massage.

To better understand how cupping works, it is important to know what happens after an injury. The earliest descriptions of acute inflammation use the terms tumor (swelling), rubor (redness), calor (warmth) and dolor (pain).

Swelling appears immediately to physically restrict the affected area from moving and potentially doing more damage. The redness and warmth are reflective of increased circulation. Pain is an important factor that limits activity of the injured muscle or joint.

Inflammation involves an intense cellular response and a cascade of chemical events at the site of injury. Specialized white blood cells called macrophages are responsible for the cleanup of tissue debris during the healing phase after an acute injury. Increasing circulation to an injured area increases the availability of macrophages.

“In various forms, cupping provides a stimulus that reduces tension in muscle, stretches connective tissue, increases blood flow to superficial tissue and may relieve pain,” states Dr. Craig Denegar, professor and department head of kinesiology at UConn. “As with many traditional treatments there is little research quantifying the benefits however, when properly administered, cupping appears to be safe.”

Cupping may be a good complementary treatment along with standard therapy for injured athletes.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Beware of heat as practice returns


Over six million children will soon be heading out to athletic fields across the country to participate in a variety of fall sports. Unfortunately, practice sessions begin during the warmest months of the year, subjecting these athletes to one of the most frequent causes of death in sports.

Heat-related illnesses are a spectrum of conditions. Muscle cramps and exhaustion are fairly common. Cramps are usually related to poor hydration and electrolyte imbalances. Many athletes have a genetic predisposition to cramping and may require salt supplements.

Heat exhaustion is a sense of fatigue that results when the demand for increased blood flow cannot be met due to dehydration and cardiac failure. This can lead to syncope (fainting) when blood supply to the brain is inadequate.

Exertional heat stroke is a medical emergency that can potentially lead to death in minutes. It involves the escalation of hyperthermia to the point that it leads to cardiac failure and coma. It must be identified and treated swiftly and aggressively.

Treatment of heat-related illnesses involves adequate hydration either orally or intravenously. Heat stroke is treated by immediate immersion into a cold bath. This is followed by emergency transport to a medical center for further evaluation, treatment and observation.

“Acclimatization is the process that allows an athlete’s body to perform in warm climates by gradually increasing the amount of exposure to extreme conditions,” reports Dr. Rebecca Stearns, Chief Operating Officer of the Korey Stringer Institute at the University of Connecticut. “Parents should be sure there is a heat acclimatization and weather policy that is followed by youth sports organizations before allowing their children to participate.”

First aid training for coaches and officials is crucial to identifying heat-related illnesses.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Performance-enhancing drug problem at new level


Among the biggest pre-Olympic stories has been the disqualification of athletes due to widespread use of performance-enhancing drugs (PEDs). Although PEDs have been a part of individual efforts to cheat, the revelation that there was a nationally sponsored program to hide the use of PEDs by Russia has taken this problem to a new level.

PEDs are medications approved to treat specific medical problems and instead are used outside of their approved use to improve athletic performance. These include anabolic steroids, banned supplements, amphetamines and diuretics.

Anabolic steroids, including testosterone, human growth hormone and androstenedione are taken to increase muscle size and strength. This will also result in improved endurance.

Many banned supplements are designed to increase muscle efficiency. Some include creatine, an essential muscle component. Another pitfall of supplements is that they are not FDA regulated and often contain unknown substances that may be banned.

Stimulants include amphetamines, caffeine and some cold remedies. These substances increase heart rate and blood pressure. Oddly, these substances can also have a negative impact on athletic performance.

Diuretics increase kidney function and urine output. This will help athletes lose weight and compete at a lower weight class in some sports. It can also result in dehydration during competition and lead to muscle cramps.

Diuretics have also been used as “masking” agents that dilute urine and make the detection of banned substances more difficult.

“The ability to avoid a positive test while using a PED has become a new science and has led to increasing competition among researchers on both sides of testing,” reports Dr. Jeffrey Anderson, Medical Director of UConn Student Health Services. His conclusions are based on his efforts to make professional and amateur athletics fair.

The incidents involving Russian athletes included a state-sponsored program to replace tainted urine with clean urine from other athletes at the time of testing.

Hopefully, this 31st Olympiad will represent a step closer to fairer play when it comes to PEDs.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Parents should take action to prevent youth concussions

More than 6.5 million children in the United States at the middle school level and younger will be participating in a high-velocity collision sport this year. Early recognition and treatment of children with head injuries can be lifesaving.

Traumatic brain injuries consist of a range of disorders with concussion being the most mild. Typical symptoms including headache, dizziness, confusion and visual abnormalities come on suddenly after a blow to the head.

Sports of the highest concern are football, hockey and soccer since they attract the highest numbers of participants in the fall and winter. This also coincides with the academic year and an injury may impede success in the classroom.

Children are a particularly challenging population given the increased vulnerability of young developing brains and a child’s inability to clearly express symptoms. Underlying medical problems including ADHD and migraine headaches are known to prolong recovery from head injury.

Early recognition of symptoms during a contest requires careful observation by coaches, parents and officials. Athletes who are slow to rise, have a staggering gait, hold their heads or hold onto another player for support after a forceful collision should be pulled from the contest for further evaluation. 

Among the most important steps parents can take to protect their children is to investigate what team they will be playing for. Meet the coaching staff to be sure their goals of promoting good health habits, team spirit and physical fitness are the same as yours. Youth sports are not boot camp and efforts should not be directed to “toughening” the participants.

Recent studies have shown that having a licensed health care professional associated with a team promotes early recognition, treatment and recovery from sports concussion.

If symptoms persist or worsen at anytime, a physician visit is warranted, preferably with someone who has special experience in treating neurologic injuries. 

Parenting a child who participates in a high-velocity collision sport requires effort.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Overuse knee injury affects young athletes

Knee pain affects many Americans. Chronic conditions including arthritis, cartilage damage and ligament tears are common. More striking is when knee pain affects athletically active adolescents. 

The knee is a complex joint consisting of bones, ligaments, tendons and cartilage. It is a weight-bearing joint that allows stable movement in multiple directions. It also provides shock absorption. 

Osgood-Schlatter disease is a painful condition affecting approximately 200,000 adolescents each year in the United States. It is the result of inflammation of the tendon connecting the knee cap (patellar) and the principal weight-bearing bone of the lower leg (tibia).

 The patellar tendon attaches to the upper end of the tibia on a portion of the bone known as the tibial tuberosity. Osgood-Schlatter disease is signified by painful swelling on the tibial tuberosity. It typically occurs in males between the ages of 13-14 and girls between the ages of 12-13.

 It is particularly common in young athletes who participate in sports that require running, jumping and rapid changes in direction. Sports such as basketball, volleyball, gymnastics, soccer and skating seem to have the highest numbers of cases. 

“Osgood-Schlatter disease is the result of a traction where two ends of bone intersect in a skeletally immature person,” reports Dr. Cory Edgar an orthopedic surgeon at UConn who specializes in sports-related injuries. “This is an overuse type of injury and should serve as a sign to rest and modify workouts.”

A common misconception is that Osgood-Schlatter will lead to a fracture or tendon rupture if untreated. It actually will cause chronic pain that will persist until the athlete’s skeletal structure matures.

Acute treatment consists of early diagnosis followed by rest, ice and anti-inflammatory medications. Stretching of the quadriceps muscle is an important part of rehabilitation.

Like other overuse injuries, moderation is key to a successful recovery.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu