Pharmacologic Considerations for Patients With Concussion

What are the symptoms of a concussion?

Symptoms of a concussion (also called mild traumatic brain injury) can include headache, nausea and/or vomiting, vision problems, dizziness, cognitive impairment, irritability, anxiety, and sleep problems.¹

Symptoms typically show up right away; however, they can develop hours to days following a head injury.¹

Patients with “alarm” symptoms (e.g., loss of consciousness, seizures, repeated vomiting) should seek immediate medical attention.²

Resolution of concussion symptoms typically occurs within one to four weeks.^1,2

• Post-concussion syndrome refers to symptoms that last beyond the expected recovery period.³

Patients with concussions may exhibit new symptoms, concurrent injury symptoms (e.g., whiplash), or they may have worsening symptoms related to prior chronic issues (e.g., ADHD, depression, migraines, anxiety).⁵

• Pre-injury psychiatric issues (e.g., depression, anxiety) can increase the risk for post-concussion syndrome.^4,5

How can headache be treated in the early stages of a concussion?

Acetaminophen or ibuprofen can be used to treat headache after a concussion.^1,4,13

• Some experts recommend avoiding NSAIDs for 24 to 72 hours following a concussion, due to a theoretical bleeding risk and the potential for an intracranial bleed.^4,14

Which meds should be avoided in patients who have a concussion?

Patients with a concussion should try to avoid meds that may worsen, mimic, or mask symptoms of the concussion or that may interfere with mental status changes and medical evaluations (e.g., benzodiazepines, high-dose analgesics, other sedatives).⁵

How should patients with a concussion who are taking antithrombotics be managed?

Patients taking antithrombotics (e.g., aspirin, warfarin, clopidogrel, etc) may be at an increased risk of intracranial bleeding following a concussion.

• These patients should be assessed urgently to determine bleeding risk and/or the need for brain imaging.⁶

Are meds recommended to treat acute concussion or post-concussion syndrome?

There are no recommended medications for the specific treatment of either acute concussion or post-concussion syndrome due a lack of efficacy and safety evidence.^1,4,5

However, meds are sometimes used to treat symptoms that accompany concussion (e.g., sleep disorders, migraines, depression). These conditions are generally managed with the same meds that are used in patients without a concussion.⁴

Which meds have been studied for use in patients with post-concussion syndrome?

There are multiple studies using various medications (e.g., methylphenidate, sertraline, ondansetron, amitriptyline, topiramate, amantadine, and melatonin) in patients with concussion; however, they are of low quality and generally lack clinically meaningful data.^1,4,7,8,9,15

What supplements or home remedies are promoted as treatments for concussion?

There are many supplements, homeopathic products, essential oils, and herbal teas that are promoted to help patients with concussions. These products are not recommended for the treatment of concussion due to a lack of efficacy and safety data.^10,11

Examples include horse chestnut, piracetam, ascorbic acid (vitamin C), vitamin E, magnesium, riboflavin, coenzyme Q10, B vitamins, omega-3 fatty acids, curcumin (turmeric), vitamin D, progesterone, N-methyl-D-aspartate, exogenous ketones, and dietary manipulations (e.g., ketogenic diet).^1,9-11

• Piracetam has been found in some products promoted to treat concussion. This medication is not approved in the U.S. or Canada, and was rejected by the FDA as a supplement in 2004.¹²
• Vitamin C’s antioxidant properties theoretically could improve concussion symptoms; however, there are some weak data that suggest its use causes further cellular injury in the brain.⁹