How would you treat a headache occurring during a game without any reported trauma to the head, especially in an athlete with a history of concussion?

Treatment of Headache During a Game Without Head Trauma

For a headache occurring during a game without any reported head trauma, treatment should focus on rest, hydration, and over-the-counter pain medication, with careful monitoring for worsening symptoms that might indicate a more serious condition.

Initial Assessment

When an athlete develops a headache during a game without any apparent head trauma, it's important to:

• Assess vital signs and neurological status
• Evaluate for any signs of dehydration
• Check for any symptoms that might suggest a more serious condition
• Consider the athlete's history, particularly any previous concussions

Treatment Algorithm

Step 1: Remove from Play and Initial Management

• Remove the athlete from play temporarily
• Have them rest in a quiet, cool environment
• Provide hydration (water or electrolyte drinks)
• Consider over-the-counter pain medication:
  • Acetaminophen (preferred initial option)
  • NSAIDs like ibuprofen if no contraindications

Step 2: Evaluate for Red Flags

Monitor for concerning symptoms that would require immediate medical attention:

• Severe, sudden-onset headache ("worst headache of life")
• Altered mental status or confusion
• Neck stiffness
• Focal neurological deficits
• Visual disturbances
• Nausea/vomiting
• Dizziness or balance problems

Step 3: Decision Making Based on Symptom Resolution

• If symptoms resolve with rest and basic measures:

  • Athlete may return to play if completely symptom-free
  • Monitor for recurrence of symptoms

• If symptoms persist or worsen:

  • Do not allow return to play
  • Arrange for medical evaluation
  • Consider possible delayed presentation of concussion or other conditions

Special Considerations

Athletes with History of Concussion

For athletes with previous concussions, headaches during games warrant extra caution, as they may represent post-concussive symptoms or increased vulnerability 1. The American Academy of Pediatrics notes that concussion symptoms can sometimes present in delayed fashion, even without a recognized impact 2.

Differentiating from Concussion

While the headache occurred without reported trauma, it's important to recognize that some athletes may not report minor impacts. According to guidelines, any athlete with suspected concussion symptoms should be removed from play and not allowed to return on the same day 1.

Monitoring Requirements

Athletes should be monitored for at least 15-30 minutes after the initial headache to ensure symptoms are not progressing, which could indicate a more serious condition.

Follow-up Recommendations

• If the headache resolves completely with basic measures and does not return, no further action may be needed
• If the headache persists beyond the game or returns with exertion, medical evaluation is recommended
• Documentation of the episode is important, especially for athletes with prior concussion history

Pitfalls to Avoid

1. Premature return to play: Allowing an athlete to return while still experiencing headache symptoms could worsen their condition, especially if the headache is an early sign of concussion 1.

2. Missing a concussion: Not all concussions involve obvious head trauma or loss of consciousness. The American Academy of Pediatrics notes that concussions can occur without direct impact to the head 2.

3. Inadequate hydration assessment: Dehydration is a common cause of headaches during athletic activity and should be addressed promptly.

4. Overlooking medical history: Athletes with history of migraines or previous concussions may have different management needs and thresholds for medical evaluation.

By following this approach, you can appropriately manage a headache that occurs during a game while ensuring athlete safety and proper medical care when needed.