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Neurosurgery. 2008 Jul;63(1):76-80; discussion 80-2. doi: 10.1227/01.NEU.0000335073.39728.CE.

Balance deficits after sports-related concussion in individuals reporting posttraumatic headache.

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Sports Medicine Research Laboratory, Department of Exercise and Sport Science, and Curriculum in Human Movement Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.



Posttraumatic headache (PTH) may affect neurocognition after sports-related concussion. To our knowledge, no studies have examined how PTH affects balance after concussion using dynamic posturography. The purpose of this study is to compare balance after concussion between athletes reporting PTH and athletes not reporting PTH.


We conducted a retrospective, repeated-measures design with participants grouped by presence of postinjury report of headache. Balance testing was conducted on 108 concussed collegiate athletes (age, 18.83 +/- 1.27 yr; height, 180.92 +/- 10.01 cm; mass, 83.29 +/- 19.62 kg). Presence of PTH during the first postinjury test session (group) and test time (baseline, postinjury) served as the independent variables. The composite equilibrium score and the somatosensory, vestibular, and visual ratio scores served as dependent variables. A 2 x 2 mixed model analysis of variance was used to analyze each outcome measure.


Significant decreases in all four measures assessed were noted after concussion compared with preseason baseline measures (P < 0.05). Significant group by test-time interactions were observed, suggesting that composite equilibrium (F1106 = 6.6089; P = 0.012) and vestibular ratio (F1106 = 7.156; P = 0.009) scores are affected by the presence of PTH. Athletes reporting PTH also demonstrated worse visual ratio scores compared with individuals not experiencing PTH (F1106 = 4.26; P = 0.041). No other significant findings were observed for the somatosensory ratio score.


Current literature proposes that PTH is associated with cognitive deficits. Our study indicates that PTH may also contribute to increased balance deficits. We believe the deficits may be a result of increased sensory organization challenges after injury. Clinicians should be mindful of these findings when managing concussed athletes reporting headache.

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