Background: Approximately 25% of collegiate student-athletes have reported a migraine history. Though medication may be helpful to those with migraine, there are many barriers to care, which may xxx affect this population. The purpose of this study was to determine if collegiate student-athletes with a self-reported history of migraine were taking medications and identify if some of the common barriers to care (i.e., provider trust, headache severity) were present. Methods: During routine pre-participation physicals, collegiate student-athletes were recruited for inclusion in the study. Participants completed questionnaires including: a health history questionnaire (e.g., age, sex, migraine history, current medications), Migraine Disability Assessment (MIDAS) and Brief Disability Questionnaire (BDQ) for migraine severity, and a modified Patient-Doctor Relationship Questionnaire-9 for provider trust. Results: Participants did not report taking prescription medications for migraine. However, over-the-counter (OTC) medications (30%), prescription medications (66.7%), and both (21.2%), were reported by individuals with migraine. From the MIDAS and BDQ, low to mild migraine severity was reported in those with migraine. Conclusion: Collegiate student-athletes self-reported migraine and taking medication for migraine at lower rates than the general population. Migraine severity was low and provider care was high.

Background Migraine, a common neurological disease, can negatively impact vestibular and oculomotor functioning. Vestibular and oculomotor function and symptomology are routinely tested in collegiate athletes as part of baseline concussion assessments. The purpose of this study was to identify how migraine history influences vestibular ocular baseline assessments in collegiate student-athletes. Methods A total of 1775 collegiate student-athletes from de-identified data provided by the National Collegiate Athletic Association – Department of Defense Grand Alliance from 2014 to 2020. Participants self-reported migraine status, sex, age, Hospital Anxiety and Depression score, and sleep were used to predict Vestibular/Ocular Motor (VOMS) provocation scores, King-Devick times, and Sport Concussion Assessment Tool (SCAT) symptom scores. Results Participants with migraine history have 1.75 odds of reporting abnormal baseline VOMS symptoms (≥2) than those without migraine ( p = 0.007, 95% confidence interval [CI] 1.15, 2.63). Participants with migraine also had a predicted 1.15-point higher total symptom score and a 4.1-point symptom severity increase on the SCAT. Migraine did not significantly influence King-Devick performance. Females had 1.44 odds of slower reading times on the King-Devick ( p < 0.001, 95% CI: 1.15, 1.81). Conclusions Migraine history was the highest predictor of abnormal baseline vestibular ocular performance and symptoms in collegiate student-athletes. Female sex, concussion history, sleep, and anxiety and depression history also significantly contributed to baseline concussion performance. Identification of patient history prior to test interpretation is vital for appropriate diagnosis and care.

INTRODUCTION:Service academy members are at high risk for concussions as a result of participation in both sports and military-specific training activities. Approximately 17% of active duty service members are female, and they face unique challenges in achieving timely recovery from concussions. Understanding the unique characteristics affecting return to unrestricted activity (RTA) among female service academy members is imperative for the ever-growing proportion of females across the U.S. military. The goal of this analysis was to determine how specific injury and individual characteristics of concussion affect 2 RTA protocol events in female service academy members: time to protocol initiation and time to protocol completion. MATERIALS AND METHODS:All data were collected as part of the National Collegiate Athletic Association (NCAA) and the DoD Concussion Assessment, Research and Education Consortium. We examined data from female U.S. military service academy members at the 4 U.S. Service Academy sites who sustained a concussion between Fall 2014 and Spring 2020 (N = 752). Return to unrestricted activity protocol initiation time was defined as the time from injury to when cadets were cleared to begin gradual RTA, while RTA protocol completion time was defined as the time from injury to when cadets were cleared to RTA. Multivariable Cox regression analyses were used to determine the effect of 4 characteristics on RTA event times: (1) service academy members' NCAA status (e.g., student athlete), (2) prior history of concussion, (3) reporting time of concussion, and (4) sport-related concussion (SRC) or non-SRC. Because of missing data, 520 cadets were included in the model of RTA protocol initiation and 556 were included in the model of RTA protocol completion. Chi-squared analyses assessed interactions between reporting time, NCAA status, and SRC or non-SRC. RESULTS:Service academy members who were NCAA athletes (hazard ratio [95% CI](HR [95% CI]): 1.58 [1.32, 1.90]), immediately reported their injury (HR [95% CI]: 1.40 [1.18, 1.67]), or had an SRC (HR [95% CI]: 1.29 [1.08, 1.54]) were significantly more likely to have initiated or completed the RTA protocol on any given day post-concussion compared to those who were not NCAA athletes, delayed reporting their injury, or had a non-SRC, respectively. We observed that among those with SRCs, a greater proportion of NCAA service academy members immediately reported their injury (53.9%) compared to non-NCAA (37.3%, P < .001); there was no difference in the proportion of NCAA and non-NCAA service academy members with non-SRCs who immediately reported their injury (P = .18). CONCLUSIONS:A greater proportion of female service academy members who sustained SRCs and were NCAA athletes reported their injuries immediately, which was associated with a greater likelihood of RTA protocol initiation and completion on any given day after injury. This may be attributable to easy and timely access to medical personnel (e.g., athletic trainers) or the presence of individuals trained in identifying concussion (e.g., coaches). Future initiatives among female service academy members should include improved access to medical care across a variety of injury settings and education on the importance of early reporting after concussion.

Context : The concept of anatomical fascial trains and myofascial release are heavily researched topics independently. However, few studies have determined if myofascial release of remote areas can cause lengthening throughout more distal aspects of these fascial trains. Clinical Question : In healthy individuals, what is the effect of myofascial release on the plantar aspect of the foot in improving flexibility and hamstring length as determined by a sit-and-reach test? Clinical Bottom Line : The usage of myofascial release on the plantar aspect of the foot via a firm object has been shown to improve sit-and-reach distance. Each article included for analysis utilized similar methods of instructing self-myofascial release with regard to time as well as type of object used for the intervention. Though this was consistent between studies, the authors should have implemented secondary outcome measures. Despite the limitations to each of the studies analyzed, there is a Strength of Recommendation Taxonomy (SORT) Level B evidence to support the implementation self-myofascial release to the plantar fascia. This intervention should be considered a concurrent option for individuals with range of motion deficits or fascial restrictions in the upper thigh.

OBJECTIVES:To determine whether history of traumatic brain injury (TBI) is associated with psychopathology, and, in particular, substance use disorder (SUD) in young adults with a history of athletic participation. DESIGN:Observational study. SETTING:University in the northeastern United States. PARTICIPANTS:A large (n = 534) and mixed sex (57% female) sample of varsity and club sport athletes older than 18 years. INTERVENTIONS:None. MAIN OUTCOME MEASURE:The Ohio State University Traumatic Brain Injury ID assessment and the Structured Clinical Interview for the diagnostic and statistical manual of mental disorders, fifth edition. RESULTS:Twenty-five percent of participants reported no history of head injuries, 32% reported 1 head injury, and 43% reported more than 1 head injury. Thirty-eight percent of participants had been diagnosed with 1 or more concussions. Twenty-eight percent of participants had a current psychiatric diagnosis and 49% had at least 1 lifetime diagnosis. Head injuries and concussions were significantly associated with the presence of lifetime psychiatric diagnosis and symptoms or diagnosis of alcohol or SUD. More head injuries were associated with symptoms of post-traumatic stress disorder. CONCLUSIONS:Higher number of self-reported head injuries and diagnosed concussions were associated with a lifetime history of psychopathology, and specifically, with alcohol and substance use disorders. These relationships are similar to those seen in the general population of adults. The relationships also raise several interesting questions about recovery from head injuries in young adult athletes.

Objective This cross-sectional study evaluated de-identified data from the National Collegiate Athletic Association-Department of Defense Grand Alliance from 2014 to 2020 to determine the prevalence of migraine and migraine medication and to describe differences in migraine prevalence by sex, race, and sport. Background Epidemiological studies can help identify underdiagnosed and undertreated populations. Understanding migraine prevalence in collegiate student-athletes is essential for positive healthcare outcomes including development of prevention and treatment plans. Methods From a concussion baseline assessment, participant's self-reported demographics (e.g., age, sex, sport), migraine diagnosis (i.e., yes/no), and migraine medication usage (e.g., yes/no, type) determined prevalence of migraine and medication use in collegiate student-athletes. Results Migraine was reported in 5.6% (2617/47,060; 95% confidence interval [CI] 5.4%-5.8%) of the student-athletes, with higher prevalence in females, 7.5% (1319/17,628; 95% CI 7.1%-7.9%), than males, 4.6% (1298/28,116; 95% CI 4.4%-4.9%). Medication usage was reported by 36.2% (947/2617; 95% CI 34.3%-38.0%) of individuals with migraine. Migraine reporting differed by race, with Caucasian reporting highest (5.9%; 1990/33,913; 95% CI 5.6%-6.1%) and Asian the lowest (2.7%; 55/2027; 95% CI 2.1%-3.5%). Women's sports, including golf, gymnastics, and lacrosse, and men's diving and squash had higher migraine reporting than other sports. Conclusion Caucasian females reported higher rates than other groups and sport influenced rates of migraine diagnosis.

CONTEXT:Concussion research has primarily focused on sport-related mechanisms and excluded non-sport-related mechanisms. In adult populations, non-sport-related concussions (non-SRCs) demonstrated worse clinical outcomes compared with sport-related concussions (SRCs); however, investigations of non-SRCs in college-aged patients are limited.OBJECTIVES:To examine clinical outcomes in collegiate athletes with non-SRCs compared with SRCs and explore sex differences in outcomes among collegiate athletes with non-SRCs.DESIGN:Prospective cohort study.SETTING:Clinical setting.PATIENTS OR OTHER PARTICIPANTS:A total of 3500 athletes were included (n = 555 with non-SRCs, 42.5% female) from colleges or universities and service academies participating in the National Collegiate Athletic Association Department of Defense Concussion Assessment, Research and Education (CARE) Consortium.MAIN OUTCOME MEASURE(S):Dichotomous outcomes (yes or no) consisted of immediate reporting, mental status alterations, loss of consciousness, posttraumatic amnesia, retrograde amnesia, motor impairments, delayed symptom presentation, and required hospital transport. Continuous outcomes were symptom severity, days with concussion symptoms, and days lost to injury. Data were collected within 24 to 48 hours of injury and at return to play. Adjusted relative risks (ARRs) compared the likelihood of dichotomous outcomes by mechanism and by sex within patients with non-SRCs. Multivariate negative binomial regressions were used to assess group differences in continuous variables.RESULTS:Athletes with non-SRCs were less likely to report immediately (ARR = 0.73, 95% CI = 0.65, 0.81) and more likely to report delayed symptom presentation (ARR = 1.17, 95% CI = 1.03, 1.32), loss of consciousness (ARR = 3.15, 95% CI = 2.32, 4.28), retrograde amnesia (ARR = 1.77, 95% CI = 1.22, 2.57), and motor impairment (ARR = 1.45, 95% CI = 1.14, 1.84). Athletes with non-SRCs described greater symptom severity, more symptomatic days, and more days lost to injury (P < .001) compared with those who had SRCs. Within the non-SRC group, female athletes indicated greater symptom severity, more symptomatic days, and more days lost to injury (P < .03) than male athletes.CONCLUSIONS:Athletes with non-SRCs had worse postinjury outcomes compared with those who had SRCs, and female athletes with non-SRCs had worse recovery metrics than male athletes. Our findings suggest that further investigation of individuals with non-SRCs is needed to improve concussion reporting and management.

BackgroundHaving an intellectual disability increases the likelihood for exhibiting impairments in vision, hearing, and balance. The intersection of these issues has yet to be described in a large cohort.MethodsBy hosting the largest public health database for individuals with intellectual disability, Special Olympics (SO) offers similar to 120,000 assessments completed at competitions between 2007 and 2018.ResultsOf SO athletes assessed for vision (N = 52,521), hearing (N = 35,073), and balance (N = 31,446), 74%, 28%, and 51% demonstrated a deficit, respectively. Thirteen percent of athletes presenting to three assessments (N = 7,887) showed concurrent impairments.ConclusionsThe high prevalence of sensory and balance impairments at younger ages (M = 28.8, SD = 14.15) compared to the general population highlights disparities faced by the intellectual disability community and should guide public health policy for improved screening and counselling.

CONTEXTConcussion research has primarily focused on sport-related mechanisms and excluded non-sport related mechanisms. In adult populations, non-sport related concussions (non-SRC) demonstrate worse clinical outcomes relative to sport-related concussions (SRC); however, there is limited research examining non-SRC in college-aged patients.OBJECTIVEExamine clinical outcomes in collegiate athletes with non-SRC compared to SRC and examine sex differences in outcomes within non-SRC.DESIGNProspective cohort.SETTINGClinical setting.PARTICIPANTSA total of 3,500 athletes were included (n=555 non-SRC; 42.5% female) from colleges/universities and service academies participating in the National Collegiate Athletic Association-Department of Defense Concussion Assessment, Research, and Education (CARE) Consortium.MAIN OUTCOME MEASURESDichotomous outcomes (yes/no) included immediate reporting, mental status alterations, loss of consciousness (LOC), posttraumatic amnesia (PTA), retrograde amnesia (RGA), motor impairments, delayed symptom presentation, and requiring hospital transport. Continuous outcomes included symptom severity, days with concussion symptoms, and days lost to injury. Data were collected within 24-48 hours and at return-to-play. Adjusted relative risk (ARR) compared the likelihood of dichotomous outcomes by mechanism and by sex within non-SRC. Multivariate negative binomial regressions were used to assess group differences in continuous variables.RESULTSAthletes with non-SRC were less likely to report immediately (ARR=0.73, 95%CI=0.65-0.81) and more likely to report delayed symptom presentation (ARR=1.17, 95%CI=1.03-1.32), LOC (ARR=3.15, 95%CI=2.32-4.28), RGA (ARR=1.77, 95%CI=1.22-2.57), and motor impairment (ARR=1.45, 95%CI=1.14-1.84). Athletes with non-SRC reported greater symptom severity, more symptomatic days, and more days lost to injury (P<0.001) relative to SRC. Within non-SRC, female athletes reported with greater symptom severity, more symptomatic days, and more days lost to injury (P<0.03) compared to male athletes.CONCLUSIONSAthletes with non-SRC had worse post-injury outcomes relative to SRC and females with non-SRC had worse recovery metrics relative to males. Our findings suggest that further investigation of individuals with non-SRC is needed to improve concussion reporting and management.

Concussion and migraine are significant healthcare concerns with similar symptomology, affecting populations that athletic trainers (ATs) interact with daily. Appropriate diagnosis and management of these conditions is vital to better health outcomes. The purpose of this study was to identify ATs current knowledge, attitudes, and beliefs regarding migraine and concussion. A random convenience sample of 4,000 ATs from the National Athletic Trainers’ Association membership and additional targeted AT groups through social media were recruited for participation in a novel electronic survey. Concussion, migraine, and comorbid condition knowledge, attitudes, and beliefs were measured using frequencies and Likert scales. Regression analyses estimated the relationship of age, gender, years of experience, clinical setting, and prior education on these outcomes. A total of 576 ATs (male = 351; 60.9

The purpose of this study was to determine sex differences in recovery trajectories of assessments for sport-related concussion using Concussion Assessment, Research and Education (CARE) Consortium data. National Collegiate Athletic Association athletes (N = 906; 61

Background and Aim: Mental health concerns, particularly anxiety and depression, are leading causes of disability in young adults. Identifying pre-existing conditions that place individuals at-risk for mental health disability may enable health-care providers to increase patient outcomes with early interventions and condition management. Methods: Student-athletes were grouped by self-reported mental health disability status during pre-season baseline physicals. During the pre-season baseline assessment, student athletes completed the post-concussion symptom scale, hospital anxiety and disability scale, short-form 12 survey, and health history questionnaire. A logistic regression was performed to examine the predictive value of previous concussion history, anxiety, and/or depression mental health disability status. Results: Student-athletes with a previous concussion had a 46% higher risk for mental health disability. Higher PROM anxiety and depression scores were associated with a 1.29- and 1.19-times higher risk of mental health disability, respectively. Conclusion: The previous concussion history placed collegiate student-athletes at higher risk for mental health disability. Further, student-athletes that had higher anxiety and depression PROM scores were more likely to have self-reported diagnosed mental health disability. Health-care professionals working with collegiate student-athletes can identify pre-existing conditions that may put a student-athlete at higher risk for mental health disability. Relevance for Patients: The present study identifies previous concussion history and prior mental health diagnoses places individuals at higher risk for the future mental health disability. Identification of these individuals during routine health screenings may improve overall health outcomes.

The purpose of this study was to assess changes in cervical musculature throughout contact-heavy collegiate ice hockey practices during a regular season of NCAA Division III ice hockey teams. In this cross-sectional study, 36 (male n = 13; female n = 23) ice hockey players participated. Data were collected over 3 testing sessions (baseline; pre-practice; post-practice). Neck circumference, neck length, head-neck segment length, isometric strength and electromyography (EMG) activity for flexion and extension were assessed. Assessments were completed approximately 1h before a contact-heavy practice and 15 min after practice. For sternocleidomastoid (SCM) muscles, males had significantly greater peak force and greater time to peak force versus females. For both left and right SCMs, both sexes had significantly greater peak EMG activity pre-practice versus baseline, and right (dominant side) SCM time to peak EMG activity was decreased post-practice compared to pre-practice. There were no significant differences for EMG activity of the upper trapezius musculature, over time or between sexes. Sex differences observed in SCM force and activation patterns of the dominant side SCM may contribute to head stabilization during head impacts. Our study is the first investigation to report changes in cervical muscle strength in men's and women's ice hockey players in the practical setting.

Clinical Question: Do sports-related mild traumatic brain injury in adolescents and young adults produce changes that can be identified with functional magnetic resonance imaging that are associated with memory impairment? Clinical Bottom Line: After sport-related mild traumatic brain injury, functional magnetic resonance imaging identified inconsistent structural changes (e.g., cortical thickness changes, brain activation patterns), and negative performance changes in memory function (e.g., lower neuropsychological scores) in adolescents and young adults 9 days to more than a year following injury.

. Glial cell-derived EV concentrations were significantly higher among athletes with acute SRC compared to controls, while neuron-derived EVs did not differ. Our results suggest that analysis of brain cell-specific EVs may shed new light on a way to leverage EV-based biomarker discovery for SRC.

Objective: The purpose of this study was to determine the effects of premorbid headache status on vestibular and oculomotor baseline tests in collegiate club athletes. Design: Retrospective case–control study. Setting: Sport Concussion Laboratory. Patients (or Participants): Collegiate club athletes with a self-reported premorbid headache history (n = 32, 19.50 ± 1.98 years, and 31% women) and age–sex–sport–matched controls (n = 32, 19.56 ± 1.47 years, and 31% women) without a self-reported headache history were included. Interventions: Participants were grouped based on a self-reported headache history at baseline. Controls were randomly matched to self-reported headache participants by age, sex, and sport. Main Outcome Measures: Vestibular/ocular motor screen (VOMS) baseline symptoms, symptom provocation, near point of convergence (NPC) distance, and King–Devick (K-D) test time were compared between groups. Results: Athletes with a self-reported headache history at baseline are 3.82 times more likely to have abnormal NPC scores (P = 0.032) and 4.76 times more likely to have abnormal K-D test times (P = 0.014) than those without a headache history. There was no difference in VOMS baseline symptoms or symptom provocation between groups (P > 0.05). Conclusions: Club collegiate athletes with a headache history were more likely to screen as abnormal during a vestibular/ocular motor function assessment than athletes without a history of headaches. Healthcare professionals should screen for pre-existing headache during baseline concussion assessments before test interpretation. Clinical Relevance: A premorbid headache history at preseason baseline assessment may influence vestibular and oculomotor function, and care should be taken when interpreting these individuals' tests.

The objective of this study was to explore the correlation between preseason measures of cervical sensorimotor function and musculoskeletal injury rates across a contact sport season. The authors hypothesized that athletes with higher sensorimotor dysfunction at baseline would be more likely to suffer an injury. The authors further hypothesized that contact sport participation would lead to greater changes in cervical sensorimotor function across a sport season compared with noncontact controls. Forty-nine collegiate club athletes (26 rugby and 23 noncontact controls) participated in a cohort study. Low positive correlations between baseline sign and symptom severity ( r = .383), and score ( r = .344), and cervical joint position error ( r = .385–.425) and time loss injury were observed. Combining sign and symptom severity score and the neck reposition error predicted musculoskeletal injury status with 80.8% accuracy (area under the curve = 0.80, p = .003). The results suggest preseason deficits in cervical sensorimotor function may be related to future musculoskeletal injury risk. Sign and symptom severity score, Neck Disability Index score, and cervical joint position error can help identify athletes requiring more comprehensive cervical spine assessment that may benefit from preventative intervention.

Clinical Question: In individuals with posttraumatic headache following concussion, what impact does medication have? Clinical Bottom Line: Prescription medications may be beneficial for those suffering posttraumatic headache following concussion by decreasing headache symptoms and improving cognitive function, though long-term outcomes were similar between those taking and not taking medications.