Retired NFL Players Have Increased Incidence of Headache

WASHINGTON, DC—Retired players for the National Football League (NFL) have a significantly higher incidence and frequency of headache, migraine, and chronic migraine, compared with the general population, according to a study described at the 67th Annual Meeting of the American Academy of Neurology. The former players are not receiving standard headache treatment and lack access to neurologists and headache specialists. The data also indicate that traumatic brain injury (TBI), as measured on diffusion tensor imaging (DTI) MRI, is related to an increased incidence of concussion and headache frequency.

Francis Conidi, MD, sports neurologist in Port Saint Lucie, Florida, and colleagues began a prospective study to determine the incidence and phenotype of headache in retired NFL players. The researchers also intended to compare these results with markers for TBI. Each participant underwent a two-day examination that included a comprehensive neurologic and headache history, a neurologic examination, a neuropsychologic evaluation, the Clinical Dementia Rating (CDR) Scale, a psychologic evaluation, and DTI MRI.

Length of Career Influenced Headache Days
Dr. Conidi presented the data for the first eight study participants. The mean age of the retired players was 37.1. Participants had played an average of 4.6 years in the NFL and reported, on average, having 7.25 concussions in their lifetimes. The maximum number of reported concussions was 15. No player had evidence of amyotrophic lateral sclerosis or Parkinson’s disease. The players’ mean CDR score was 0.69.

Study participants reported a mean of 19.4 headache days per month, and three players reported 30 headache days per month. A total of 12.38 headache days were considered severe according to the third edition of the International Headache Classification. In addition, 38% of players met the updated criteria for chronic migraine. Patients with headaches generally had had headaches for about eight years. Patients with chronic migraine had had the condition for eight years. None of the retired NFL players reported any significant headache history before college.

Statistical analysis indicated a correlation between the number of years played in the NFL and the number of headache days. The researchers also found a correlation between the number of concussions and the number of headache days.

Seven participants had depression and anxiety. About 63% of the population had abnormalities in attention and concentration, 50% had problems with learning and memory and executive functioning, and 38% had problems with spatial perceptual function. All players with chronic migraine had significant abnormalities in attention, concentration, learning, and memory. Patients with daily headache also had significant abnormalities on neuropsychologic tests for attention, concentration, and spatial perception.

Three players had positive DTI findings, and three players had evidence of diffuse axonal injury on conventional MRI. Two of the three players with positive DTI MRI had more than 10 headaches per month.

“Almost all retired players had a history of underlying depression and anxiety, which, in itself, could be a trigger or consequence of their increased headache frequency,” said Dr. Conidi. “It also may be a result of the anxiety developing when they realize that they are starting to suffer neurocognitive deficits.”

Players Lacked Adequate Care
Study limitations included a low sample size and the lack of an objective measure of concussion or an objective measure of headache frequency.

“Perhaps the most striking thing that we found was that none of these players had access to healthcare,” he continued. None of the players had insurance. The potential settlement of the NFL lawsuit over concussions, however, may provide these athletes with access to neurologic care, Dr. Conidi concluded.

—Erik Greb

WASHINGTON, DC—Retired players for the National Football League (NFL) have a significantly higher incidence and frequency of headache, migraine, and chronic migraine, compared with the general population, according to a study described at the 67th Annual Meeting of the American Academy of Neurology. The former players are not receiving standard headache treatment and lack access to neurologists and headache specialists. The data also indicate that traumatic brain injury (TBI), as measured on diffusion tensor imaging (DTI) MRI, is related to an increased incidence of concussion and headache frequency.

Francis Conidi, MD, sports neurologist in Port Saint Lucie, Florida, and colleagues began a prospective study to determine the incidence and phenotype of headache in retired NFL players. The researchers also intended to compare these results with markers for TBI. Each participant underwent a two-day examination that included a comprehensive neurologic and headache history, a neurologic examination, a neuropsychologic evaluation, the Clinical Dementia Rating (CDR) Scale, a psychologic evaluation, and DTI MRI.

Length of Career Influenced Headache Days
Dr. Conidi presented the data for the first eight study participants. The mean age of the retired players was 37.1. Participants had played an average of 4.6 years in the NFL and reported, on average, having 7.25 concussions in their lifetimes. The maximum number of reported concussions was 15. No player had evidence of amyotrophic lateral sclerosis or Parkinson’s disease. The players’ mean CDR score was 0.69.

Study participants reported a mean of 19.4 headache days per month, and three players reported 30 headache days per month. A total of 12.38 headache days were considered severe according to the third edition of the International Headache Classification. In addition, 38% of players met the updated criteria for chronic migraine. Patients with headaches generally had had headaches for about eight years. Patients with chronic migraine had had the condition for eight years. None of the retired NFL players reported any significant headache history before college.

Statistical analysis indicated a correlation between the number of years played in the NFL and the number of headache days. The researchers also found a correlation between the number of concussions and the number of headache days.

Seven participants had depression and anxiety. About 63% of the population had abnormalities in attention and concentration, 50% had problems with learning and memory and executive functioning, and 38% had problems with spatial perceptual function. All players with chronic migraine had significant abnormalities in attention, concentration, learning, and memory. Patients with daily headache also had significant abnormalities on neuropsychologic tests for attention, concentration, and spatial perception.

Three players had positive DTI findings, and three players had evidence of diffuse axonal injury on conventional MRI. Two of the three players with positive DTI MRI had more than 10 headaches per month.

“Almost all retired players had a history of underlying depression and anxiety, which, in itself, could be a trigger or consequence of their increased headache frequency,” said Dr. Conidi. “It also may be a result of the anxiety developing when they realize that they are starting to suffer neurocognitive deficits.”

Players Lacked Adequate Care
Study limitations included a low sample size and the lack of an objective measure of concussion or an objective measure of headache frequency.

“Perhaps the most striking thing that we found was that none of these players had access to healthcare,” he continued. None of the players had insurance. The potential settlement of the NFL lawsuit over concussions, however, may provide these athletes with access to neurologic care, Dr. Conidi concluded.

—Erik Greb

WASHINGTON, DC—Retired players for the National Football League (NFL) have a significantly higher incidence and frequency of headache, migraine, and chronic migraine, compared with the general population, according to a study described at the 67th Annual Meeting of the American Academy of Neurology. The former players are not receiving standard headache treatment and lack access to neurologists and headache specialists. The data also indicate that traumatic brain injury (TBI), as measured on diffusion tensor imaging (DTI) MRI, is related to an increased incidence of concussion and headache frequency.

Francis Conidi, MD, sports neurologist in Port Saint Lucie, Florida, and colleagues began a prospective study to determine the incidence and phenotype of headache in retired NFL players. The researchers also intended to compare these results with markers for TBI. Each participant underwent a two-day examination that included a comprehensive neurologic and headache history, a neurologic examination, a neuropsychologic evaluation, the Clinical Dementia Rating (CDR) Scale, a psychologic evaluation, and DTI MRI.

Length of Career Influenced Headache Days
Dr. Conidi presented the data for the first eight study participants. The mean age of the retired players was 37.1. Participants had played an average of 4.6 years in the NFL and reported, on average, having 7.25 concussions in their lifetimes. The maximum number of reported concussions was 15. No player had evidence of amyotrophic lateral sclerosis or Parkinson’s disease. The players’ mean CDR score was 0.69.

Study participants reported a mean of 19.4 headache days per month, and three players reported 30 headache days per month. A total of 12.38 headache days were considered severe according to the third edition of the International Headache Classification. In addition, 38% of players met the updated criteria for chronic migraine. Patients with headaches generally had had headaches for about eight years. Patients with chronic migraine had had the condition for eight years. None of the retired NFL players reported any significant headache history before college.

Statistical analysis indicated a correlation between the number of years played in the NFL and the number of headache days. The researchers also found a correlation between the number of concussions and the number of headache days.

Seven participants had depression and anxiety. About 63% of the population had abnormalities in attention and concentration, 50% had problems with learning and memory and executive functioning, and 38% had problems with spatial perceptual function. All players with chronic migraine had significant abnormalities in attention, concentration, learning, and memory. Patients with daily headache also had significant abnormalities on neuropsychologic tests for attention, concentration, and spatial perception.

Three players had positive DTI findings, and three players had evidence of diffuse axonal injury on conventional MRI. Two of the three players with positive DTI MRI had more than 10 headaches per month.

“Almost all retired players had a history of underlying depression and anxiety, which, in itself, could be a trigger or consequence of their increased headache frequency,” said Dr. Conidi. “It also may be a result of the anxiety developing when they realize that they are starting to suffer neurocognitive deficits.”

Players Lacked Adequate Care
Study limitations included a low sample size and the lack of an objective measure of concussion or an objective measure of headache frequency.

“Perhaps the most striking thing that we found was that none of these players had access to healthcare,” he continued. None of the players had insurance. The potential settlement of the NFL lawsuit over concussions, however, may provide these athletes with access to neurologic care, Dr. Conidi concluded.

—Erik Greb