Objective
The impact of poor sleep quality and reduced sleep duration on preseason baseline symptom reporting is well documented. Some studies have also reported greater baseline symptom reporting in student athletes with a history of migraine. However, the interaction between having a history of migraine and less sleep on baseline symptoms is presently unknown. The purpose of this study was to examine the relationship between sleep duration, migraine history, and baseline symptom reporting in student athletes.  

Methods
From a baseline database of 30,738 athletes ages 13-18 who had not sustained a concussion in the past 6 months and completed relevant sections of ImPACT® (including the number of hours slept the night before), 19,077 individuals denied having developmental and health conditions (Controls; Mage = 15.38, SD = 1.29; 48.1% female) and 2,162 reported having had treatment for migraines (Migraine; Mage = 15.63, SD = 1.33; 48.7% females). Athletes completed the Post-Concussion Symptom Scale within ImPACT®. Athletes were divided into four groups based on their sleep duration the night before testing (≤5, 5.5-6.5, 7-8.5, and ≥9 hours). Mann-Whitney U-Tests were used to compare baseline symptom reporting between athletes with migraine history and controls, stratified by sex and sleep duration. 

Results
Athletes with migraine history were more likely to be in the ≤5 hours of sleep group the night before preseason testing compared to athletes without comorbidities (girls: χ2(1)=34.48, p<.001; boys: χ2(1)=12.58, p<.001). Athletes with migraine history also reported greater symptom severity than controls when stratified by gender and sleep duration (all ps<.001). A similar pattern was observed even when excluding symptoms directly related to sleep, fatigue, and drowsiness (all ps<.001). In athletes who slept 5 or fewer hours, 73.4% of girls and 48.1% of boys with a history of migraine reported having a symptom burden resembling an ICD-10 diagnosis of postconcussional syndrome, compared to 46.9% of girls and 29.5% of boys without any comorbidities (girls: χ2(1)=14.48, p=<.001; boys: χ2(1)=6.92, p=.008). 

Conclusions
Reduced sleep duration and migraine history, in combination, affect the severity of symptom reporting and confound baseline symptom reporting. It may be important to consider the effects of pre-existing health conditions, sex, and sleep duration when interpreting baseline symptoms.

The Impact of Migraine History and Short Sleep Duration on Preseason Symptom Reporting in Adolescent Student Athletes