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Migraine in Athletes

Migraine headaches affect 28 million Americans.  While it is not surprising that many migraine sufferers are also athletes, participation in sports presents a therapeutic challenge.

Migraine headaches are best defined as recurrent headaches that can last anywhere from 4 to 72 hours.  Symptoms include pulsating head pain sometimes accompanied by sensitivity to light and sound, along with nausea and vomiting.

The intense pain of a migraine episode can be precipitated and aggravated by head trauma and physical exertion.  Understandably, those factors present tremendous obstacles to effective treatment in athletes.  Other migraine precipitants include changes in diet, erratic sleep habits and changes in altitude.

Migraine appears to be a disorder involving both the nerves and blood vessels of the brain.  After a triggering event, a chemical cascade begins resulting in dilation of blood vessels in the brain and stretching of nerve endings.  The goal of treatment is interrupting or avoiding the chemical cascade before the onset of pain.

Assuring the optimal health and performance of athletes is the responsibility of all sports medicine professionals.  Rapid, effective intervention can make the difference in winning or losing a decisive contest.

Terrell Davis, a known migraine sufferer, serves as a good example.  In Super Bowl XXXII he was kicked in the head during the second quarter.  This triggered a visual aura followed by a headache.  The aura left him visually impaired and he was unable to play.  At halftime, he was treated with intranasal DHE, a vasoconstrictive medication, and returned in the fourth quarter to become MVP.  He later became a spokesman for that medication.

Many effective medications are available for the treatment of migraine but the best approach is often a combination of medications and a regular daily routine. 

Anthony G. Alessi, MD, is Stroke Center Medical Director at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC, in Norwich. E-mail him at aalessi@wwbh.org, or listen to his podcasts, comment on his blog or buy his book at www.backushospital.org.