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Sidelining Football Players with Headaches

Headaches related to head impact in football are common. Often, these headaches go unreported. Researchers gave out questionnaires to high school and collegiate football players. Of 433 completed surveys returned, 85 percent of the players reported having a headache related to playing football. Most (81 percent) said they had a headache in at least one-fourth of their games. Yet only 16 percent alerted sideline personnel. 

Trainers and team physicians face split-decisions about players with headaches. Complaints of a headache may have resulted from a minor impact. But it may signal a serious problem, such as a concussion or more severe head injury. Making a decision to sideline a player with a headache isn't easy. Often the symptoms are vague and don't point to more serious problems.

A blow to the head may accompany symptoms of nausea and vomiting from a problem called post-concussion symptom, which happens in about 25 percent of people who've had a concussion. Most feared is an often-fatal condition called second-impact syndrome (SIS). This is thought to occur when a player has a first-time injury to the head, leading to post-concussion syndrome. Then the player has another seemingly minor head injury, walks off the field, and collapses within five minutes. Most players who have SIS end up with severe problems or even death. Notably, the only symptom leading up to the final blow is a persistent headache.

The biggest challenge is knowing what to do--and when. Some guidelines state that any player with ongoing headache symptoms shouldn't go back out on the field. The authors suggest that if these guidelines were strictly enforced, more than 20 percent of players, according to their research findings, would have to sit out. They insist that players reporting a headache should have a neurological examination. If they pass the examination and their headache symptoms aren't getting worse, it should be okay for them to return to play. 

The authors' concern is that strictly following the guidelines might lead to even less reporting of headaches. Instead, they believe sideline personnel need to use clinical judgment when making decisions about returning players with headaches to the playing field.


Robert E. Sallis and Kirk Jones. Prevalence of Headaches in Football Players. In Medicine & Science in Sports & Exercise. November 2000. Vol. 32. No. 11. Pp. 1820-1824.

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