Objective: Acute neuropsychological deficits following a concussion may be a risk factor for a prolonged recovery. Little is known about cognition in youth with pre-existing migraines who sustain a concussion. This study examined associations between pre-existing migraines and cognition acutely after a concussion. Participants and Methods: A total of 39,161 adolescent athletes underwent baseline testing, of whom 3,730 had a suspected concussion and completed a post-injury evaluation. Of the 3,730 with a suspected injury, 633 were evaluated within 3 days of injury, and 59 reported having pre-injury treatment for migraine. Using a nested case-control design, each participant with pre-injury migraine was individually matched to two injured youth without a migraine disorder (controls) based on age, sex, concussion history, and sport (total n=177; age: M=15.8, SD=1.3). ImPACT® composite scores were examined with a Mixed ANOVA (Between-Subjects=group, Within-subjects=time). Results: The migraine and control groups performed similarly at baseline (d=-0.04-0.13). The interaction term showed a group by time effect for Verbal Memory (F=4.32, p=.041) and Visual Memory (F=3.95, p=.049), such that adolescents with migraine disorders performed worse following concussion than the control participants when accounting for baseline scores. The migraine group had greater changes from baseline to post injury on Verbal Memory (d=0.74 vs. d=0.35) and Visual Memory (d=0.63 vs. d=0.29) compared to the control group. The interaction was not significant for Visual Motor Speed (p=.06) or Reaction Time (p=.79).Conclusions: Adolescents with pre-injury migraine disorders had greater acute changes in memory scores from a concussion than those without migraine disorders.