Moran Ryan N, Covassin Tracey, Wallace Jessica
1Athletic Training Research Laboratory, Department of Health Science, The University of Alabama, Tuscaloosa, Alabama.
2Sport Injury Research Laboratory, Department of Kinesiology, Michigan State University, East Lansing, Michigan; and.
J Neurosurg Pediatr. 2019 Jan 11;23(4):465-470. doi: 10.3171/2018.10.PEDS18425. Print 2019 Apr 1.
Migraine history has recently been identified as a risk factor for concussion and recovery. The authors performed a cross-sectional study examining baseline outcome measures on newly developed and implemented concussion assessment tools in pediatrics. The purpose of this study was to examine the effects of premorbid, diagnosed migraine headaches as a risk factor on vestibular and oculomotor baseline assessment in pediatric athletes.
Pediatric athletes between the ages of 8 and 14 years with a diagnosed history of migraine headache (n = 28) and matched controls without a history of diagnosed migraine headache (n = 28) were administered a baseline concussion assessment battery, consisting of the Vestibular/Ocular Motor Screening (VOMS), near point of convergence (NPC), and the King-Devick (K-D) tests. Between-groups comparisons were performed for vestibular symptoms and provocation scores on the VOMS (smooth pursuit, saccades, convergence, vestibular/ocular reflex, visual motion sensitivity), NPC (average distance), and K-D (time).
Individuals diagnosed with migraine headaches reported greater VOMS smooth pursuit scores (p = 0.02), convergence scores (p = 0.04), vestibular ocular reflex scores (p value range 0.002-0.04), and visual motion sensitivity scores (p = 0.009). Differences were also observed on K-D oculomotor performance with worse times in those diagnosed with migraine headache (p = 0.02). No differences were reported on NPC distance (p = 0.06) or headache symptom reporting (p = 0.07) prior to the VOMS assessment.
Pediatric athletes diagnosed with migraine headaches reported higher baseline symptom provocation scores on the VOMS. Athletes with migraine headaches also performed worse on the K-D test, further illustrating the influence of premorbid migraine headaches as a risk factor for elevated concussion assessment outcomes at baseline. Special consideration may be warranted for post-concussion assessment in athletes with migraine headaches.
偏头痛病史最近被确定为脑震荡及恢复的一个风险因素。作者进行了一项横断面研究，对儿科新开发并实施的脑震荡评估工具的基线结局指标进行检查。本研究的目的是探讨病前被诊断为偏头痛的头痛作为一个风险因素对儿科运动员前庭和动眼神经基线评估的影响。
对8至14岁有偏头痛头痛诊断病史的儿科运动员（n = 28）和无偏头痛头痛诊断病史的匹配对照组（n = 28）进行基线脑震荡评估，评估项目包括前庭/动眼神经筛查（VOMS）、集合近点（NPC）和金-德维克（K-D）测试。对两组在VOMS（平稳跟踪、扫视、集合、前庭/眼反射、视觉运动敏感性）的前庭症状和激发分数、NPC（平均距离）以及K-D（时间）方面进行组间比较。
被诊断为偏头痛头痛的个体报告的VOMS平稳跟踪分数更高（p = 0.02）、集合分数更高（p = 0.04）、前庭眼反射分数更高（p值范围为0.002 - 0.04）以及视觉运动敏感性分数更高（p = 0.009）。在K-D动眼神经表现方面也观察到差异，被诊断为偏头痛头痛的个体时间更差（p = 0.02）。在VOMS评估前，NPC距离（p = 0.06）或头痛症状报告（p = 0.07）方面未报告差异。
被诊断为偏头痛头痛的儿科运动员在VOMS上报告的基线症状激发分数更高。患有偏头痛头痛的运动员在K-D测试中表现也更差，进一步说明了病前偏头痛头痛作为基线时脑震荡评估结果升高的一个风险因素的影响。对于患有偏头痛头痛的运动员，在脑震荡后评估中可能需要特别考虑。
