Can a child with headaches return to playing football?

Return to Play for Children with Headaches in Football

A child with headaches should not return to playing football until the headaches have completely resolved both at rest and with exertion, followed by a stepwise return-to-play protocol that takes a minimum of 5 days. 1

Assessment and Initial Management

• Any child with headaches potentially related to head trauma should be immediately removed from play and evaluated by a healthcare professional experienced in concussion management 2
• Headaches are a common symptom following sports-related head impacts, with 85% of football players reporting previous headache related to hitting in football 3
• Many athletes (81%) do not report headaches to coaches, trainers, or medical staff, creating significant risk for further injury 3
• Under no circumstances should a child with headaches return to play the same day, even if symptoms appear to resolve 1

Return-to-Play Protocol

The American Academy of Pediatrics recommends a structured, stepwise return-to-play protocol:

1. No activity: Complete physical and cognitive rest until asymptomatic 1
2. Light aerobic activity: Walking, swimming, or stationary cycling at 70% maximum heart rate; no resistance exercises 1
3. Sport-specific exercise: Football-specific drills without head impact 1
4. Noncontact training drills: More complex drills, may start light resistance training 1
5. Full-contact practice: After medical clearance, participate in normal training 1
6. Return to play: Normal game participation 1

Important Considerations

• Each stage must last a minimum of 24 hours, requiring at least 5 days to complete the full protocol 1
• If headaches or any symptoms return during any stage, the athlete must stop activity immediately 1
• Once asymptomatic for at least 24 hours, the athlete should return to the previous asymptomatic stage and attempt to progress again 1
• Pediatric and adolescent athletes typically have longer recovery times than college or professional athletes, often requiring 7-10 days or longer 1, 2
• A more conservative approach is warranted for younger athletes due to their longer cognitive recovery period 1, 2

Medical Clearance Requirements

• Any child with headaches potentially related to concussion must be evaluated and cleared by a healthcare professional before returning to play 1, 2
• Medical clearance should only be given when the athlete is completely asymptomatic both at rest and with exertion 1, 2
• The phrase "When in doubt, sit them out!" should guide management decisions 1

Special Considerations

• Athletes with multiple concussions or prolonged symptoms may require a longer rehabilitation program 1
• Consider retirement from contact sports for athletes with history of multiple concussions or prolonged symptoms 1, 4
• Parents should be educated about the risks of continued participation, as approximately two-thirds (63%) prefer their child retire from football after one or two concussions 4
• Headaches as an isolated symptom should be taken seriously, as they may indicate underlying brain injury that could lead to more serious complications if the athlete continues to play 5, 6