Systematic Review of Pre-Injury Migraine Disorder as a Risk Factor for Worse Outcome Following Sport-Related Concussion
Abstract Purpose This systematic review examined clinical outcomes (i.e., prognosis) following a sport-related concussion in athletes who have a pre-injury history of migraines. Clinical recovery was defined functionally as recovery from symptoms or full return to activities following injury. Data Selection All studies published prior to February 2019 that addressed pre-injury migraines as a possible predictor of clinical recovery from concussion were included. Broadly, the search included (i) sport/athlete-related terms, (ii) concussion-related terms, and (iii) diverse predictor/modifier terms. The following databases were utilized: PubMed, PsycINFO®, MEDLINE®, CINAHL, Cochrane Library, EMBASE, SPORTDiscus, Scopus, and Web of Science. After removing duplicates from the 9,372 identified articles, 5,888 abstracts were screened, 358 full-text articles were reviewed, and 15 articles examining pre-injury migraines as a predictor of recovery were included. Data Synthesis Most articles examined pre-injury migraines as an exploratory/secondary predictor of concussion outcome. Migraine history was predominantly based on self-report. Studies included minimal other information about this condition (e.g., age of onset, migraine frequency/severity, past treatment). Methodological rigor varied greatly across studies. Most studies did not find pre-injury migraines to be associated with concussion outcome, but several of these studies had small or very small sample sizes. Larger, better-designed studies suggested pre-injury migraines may be a risk factor for worse concussion outcome. Effect sizes were rarely reported or able to be calculated. Conclusion There is some evidence to suggest pre-injury migraines may be a vulnerability factor for a prolonged recovery following concussion. Future studies should focus on improving methodological quality when assessing the relationship between pre-injury migraines and concussion outcome.