A recent study has shed light on the impact of repetitive head trauma on the symptomatology of subsequent sport-related concussions (SRCs) in adolescents. The study, conducted by Addison Quinones, was driven by the increasing incidence of SRCs due to the growing participation of adolescents in athletics.

The research utilized a multicenter database consisting of 25,815 Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) results. The data was filtered for student-athletes aged 12–22 years old who competed in 21 different sports. The athletes were divided into two cohorts: those reporting a single prior concussion (SRC1) and those reporting two or more prior concussions (SRC2+). The study aimed to compare differences in 22 symptoms and 4 symptom clusters at baseline, first postinjury test (PI1), and second postinjury test (PI2).

The results showed no differences between SRC1 and SRC2+ at baseline. However, at PI1, the SRC2+ group had lower severity of headaches but increased nervousness, irritability, sadness, visual problems, and neuropsychiatric symptoms compared to SRC1. Multivariate analysis revealed decreased headache severity with increased prior concussion. At PI2, the SRC2+ cohort had increased cognitive, sleep, and neuropsychiatric symptoms compared to SRC1.

The study concluded that patients with a history of recurrent concussions reported a greater symptom burden in cognitive, sleep, and neuropsychiatric symptom clusters but not migraine symptoms. This distinction is crucial as migraine symptoms are often more easily distinguishable to patients, parents, and physicians. Therefore, careful assessment of specific symptoms should be considered in patients with a history of recurrent head injury prior to return to play.

Key Insights

1. The Impact of Recurrent Concussions: The study highlights the increased symptom burden in cognitive, sleep, and neuropsychiatric symptom clusters in athletes with a history of recurrent concussions. This finding underscores the need for comprehensive assessment and management of these symptoms in athletes with a history of head injuries.
2. The Role of Migraine Symptoms: Interestingly, the study found that recurrent concussions did not increase the severity of migraine symptoms. This finding is significant as migraine symptoms are often more easily identifiable, which could potentially lead to an underestimation of the impact of recurrent concussions if only migraines are considered.
3. Implications for Return to Play: The findings of the study have important implications for return-to-play decisions. Given the increased symptom burden associated with recurrent concussions, careful assessment of specific symptoms should be considered before allowing athletes with a history of head injuries to return to play.