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 firstname.lastname@example.org