Hormonal Contraceptive Influence on Baseline Vestibular/Ocular Symptomatology and Provocation for Concussion

Ryan N Moran; J Russell Guin; Christian Roehmer; Nicholas G Murray

doi:10.1177/23259671241259735

Hormonal Contraceptive Influence on Baseline Vestibular/Ocular Symptomatology and Provocation for Concussion

Orthop J Sports Med. 2024 Aug 16;12(8):23259671241259735. doi: 10.1177/23259671241259735. eCollection 2024 Aug.

Authors

Ryan N Moran¹, J Russell Guin², Christian Roehmer³, Nicholas G Murray⁴

Affiliations

¹ Department of Health Science, Athletic Training Research Laboratory, The University of Alabama, Tuscaloosa, Alabama, USA.
² Family, Internal, and Rural Medicine, College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA.
³ Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁴ School of Public Health, University of Nevada, Reno, Nevada, USA.

Abstract

Background: Hormonal contraceptives (HCs) and the menstrual cycle have been suggested to affect symptom severity and postconcussion recovery. Additionally, hormones have been a suggested rationale for sex differences between female and male athletes on concussion assessment. Researchers have yet to explore the effects of HC use on baseline symptomatology, including symptom reporting and provocation.

Purpose: To examine the influence of HC use on a baseline symptom reporting and vestibular/ocular provocation battery.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: A total of 61 college-aged individuals (21 HC-using women, 21 non-HC-using women, 19 men) were administered a baseline symptom battery consisting of the Post-Concussion Symptom Scale (PCSS), Headache Impact Test-6 (HIT-6), Pediatric Vestibular Symptom Questionnaire (PVSQ), and Vestibular/Ocular Motor Screening (VOMS). The main outcome measures consisted of PCSS symptom reporting (total symptoms, symptom severity score, and symptom factors), HIT-6 and PVSQ total scores, and VOMS item (ie, saccades, convergence, or vestibular/ocular reflex) symptom provocation scores.

Results: Significant differences were reported on HIT-6, with the highest headache reporting in the HC group (P = .026). On the PVSQ, the HC group also reported greater dizziness and unsteadiness symptoms than the non-HC group (P = .023). Similar findings existed on the PCSS, with the HC group reporting greater total symptoms (P < .001), symptom severity (P < .001), and vestibular-somatic (P = .024), cognitive-sensory (P = .004), sleep-arousal (P = .001), and affective (P < .001) factors compared with the non-HC group. Smooth pursuit (ie, following finger smoothly with eyes) was the only VOMS items with differences between groups (P = .003), with the HC group having greater provocation compared with non-HC users (P = .020).

Conclusion: HC use was associated with overall symptomatology and worse self-reported symptoms on vestibular-related inventories and concussion symptom scales and factors when compared with non-HC users and male controls. Additionally, HC users reported higher VOMS provocation scores on the smooth pursuit item than non-HC users and male controls.

Keywords: Vestibular/Ocular Motor Screening; female athlete; head injuries/concussion.