DIAGNOSIS, PROPHYLAXIS, AND TREATMENT OF HEADACHES IN THE ATHLETE

Background. Headaches are a common entity in the ambulatory population . Physicians involved in sports medicine must be able to accurately, d iagnose headaches in athletes and whether they are exacerbated by exer tion. Many medications have proven or theoretical negative effects on athletic performance. Thus, we should consider all aspects of medical management and determine which therapy is least intrusive to die athle te's performance. We planned this review because of the small number o f papers available on the effects of various medications on athletic p erformance. Methods. We used MEDLINE to search from 1992 to current ci tations, using the medical subject headings of headache, prophylaxis, treatment, review, athletes, and exercise, alone or in combination. Re sults. Fifty-two articles were identified and deemed appropriate for i nclusion in this review. Conclusions. Acute therapy for tension headac hes in the athletic population is best done with nonsteroidal anti-inf lammatory drugs. Prophylaxis of chronic, recurrent tension headaches i s best accomplished by night-time tricyclic antidepressants (especiall y nortriptyline) or selective serotonin reuptake inhibitors. Acute the rapy for athletes with migraines is best managed with sumatriptan or D HE 45 and prophylaxis can be accomplished with verapamil, antidepressa nts, or valproate. Exertional, cluster, and structural/infectious head aches are also discussed briefly.