Sounds like a Concussion, but It's Not

Jonathan Silver, MD reviewing Iverson GL et al. JAMA Pediatr 2015 Oct 12.

Symptoms that are relied on for the diagnosis of postconcussion syndrome in high-school athletes are common.

Postconcussion syndrome (PCS) is often diagnosed retrospectively by assessing current symptoms (ICD-10 requires cognitive, somatic, emotional, and sleep problems). However, researchers have questioned the specificity of these. Now, investigators have examined preseason reporting of PCS-like symptoms by over 30,000 healthy high-school students in Maine (boys, 54.1%; mean age, 15.5 years) and analyzed the relationship of symptoms to current or past health conditions (e.g., migraines, psychiatric treatment, substance abuse, attention-deficit/hyperactivity disorder [ADHD]).

Symptoms were rated on a 6-point scale (mild, 1–2; moderate, 3–4; severe, 5–6); to meet PCS criteria, symptoms had to occur in at least three categories. No participant had a recent concussion.

Overall, 19% of boys and 28% of girls met criteria for mild PCS, and 4% and 7% met moderate-PCS criteria. The presence of pre-existing conditions increased symptoms for up to 47% of boys (prior treatment of a psychiatric condition) and 72% of girls (prior treatment of substance abuse). The strongest indicators were, for boys, prior psychiatric treatment, followed by past migraine treatment, and for girls, past treatment of psychiatric disorder/substance abuse, followed by ADHD. Prior concussions were associated with symptom reporting but less strongly so than developmental and psychiatric factors.

Citation(s):

Iverson GL et al. Factors associated with concussion-like symptom reporting in high school athletes. JAMA Pediatr 2015 Oct 12; 1; [e-pub].