A Soccer Player With a Headache: Best Practices

Leah Concannon, MD; Stanley Herring, MD

Disclosures

October 03, 2012

A Soccer Player With a Headache That Won't Go Away

Jamie, a 14-year-old girl, presents to your office complaining of headaches and difficulty concentrating in school. One week ago, she was playing soccer on the school team when she collided with another player while going for a header. She doesn't think she lost consciousness, but her memory is a bit fuzzy regarding the minute or so after the hit. She continued playing, but by late in the second half, her headache was severe enough that she took herself out of the game.

She missed a few days of school owing to headaches and fatigue. She reports ongoing daily global headaches since that time; they are better in the morning and worse in the afternoon, particularly after eating lunch in the lunch hall. Reading and classes that require that she focus more are also reported to exacerbate her symptoms and have resulted in her having difficulty concentrating in school. Jamie's parents report she is more moody than usual, and she finds it difficult to spend time with her friends owing to her symptoms. She has tried going to soccer practice but found that this too worsens her symptoms. She is sleeping well and denies nausea, vomiting, dizziness, photophobia, phonophobia, and other associated symptoms.

Jamie has always been healthy except for a few minor orthopedic injuries as a result of sports participation. She and her family deny any prior concussions. She plays year-round soccer for her select team and was excited to play for her high school this season. She was diagnosed with attention-deficit/hyperactivity disorder (ADHD) at 10 years of age, but doesn't use medication because she doesn't like the side effects. Her parents divorced 3 years ago; Jamie had some anxiety at that time but feels that it is under control now.

Her mother has a history of migraine headaches; her father is healthy.

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