What is the initial treatment for post-concussion syndrome?

From the Guidelines

The initial treatment for post-concussion syndrome should focus on systematic education, instructions, advice, and guidance regarding postconcussion symptoms, symptom management, restitution, and self-care, as this approach has been shown to reduce the collective burden of postconcussion symptoms 1. The treatment plan should be initiated within the first 4 weeks after injury and provided by relevant health professionals.

Key Components of Treatment

• Symptom management: This includes addressing headaches, dizziness, balance problems, nausea, vision problems, increased sensitivity to noise and/or light, depression or mood swings, anxiety, irritability, memory problems, difficulty concentrating or paying attention, sleep difficulties, and feeling tired all the time 1.
• Gradual return to normal activities: Patients should refrain from strenuous mental or physical activity until they are symptom-free, and may require 2 to 3 days off work or school 1.
• Patient education: Educating patients about the typically self-limiting nature of symptoms is crucial, as most post-concussion symptoms resolve within 3 months 1.
• Referral to specialists: If symptoms persist beyond 3 months or worsen, referral to specialists in neurology, neuropsychology, or rehabilitation medicine is warranted for more targeted interventions 1.

Additional Interventions

• Graded physical exercise: Consider offering graded physical exercise in addition to other treatment to patients with persistent postconcussion symptoms, as it has been shown to improve physical functioning and reduce symptoms 1.
• Vestibular rehabilitation: Consider offering vestibular rehabilitation in addition to other treatments to patients who experience persistent vestibular dysfunction after concussion, as it has been shown to improve vestibular dysfunction and reduce symptoms 1.
• Spinal manual therapy: Consider offering manual treatment of neck and spine in addition to other treatments to patients with persistent symptoms after concussion, as it has been shown to improve physical functioning and reduce pain 1.

From the Research

Initial Treatment for Post-Concussion Syndrome

The initial treatment for post-concussion syndrome (PCS) involves a multi-disciplinary and individualized approach. Key aspects of treatment include:

• Identifying underlying symptom generators and addressing them specifically 2
• Implementing sub-symptom threshold aerobic exercise, which has been shown to be beneficial for both early and late-phase disorders after concussion 2, 3
• Utilizing cervical physical therapy, vestibular therapy, and vision therapy as needed 2
• Providing cognitive rehabilitation and cognitive behavioral therapy to manage cognitive and emotional symptoms 2, 4
• Considering pharmacological management for specific symptoms such as post-traumatic headaches, cognitive symptoms, and emotional symptoms 4

Components of Treatment

Treatment components may vary depending on the patient's specific symptoms and needs. These can include:

• Aerobic exercise, which has been found to aid in recovery and is recommended at a submaximal level 5
• Cognitive therapy to address cognitive symptoms and facilitate return to learning and other activities 4
• Emotional support and therapy, such as cognitive behavioral therapy, to manage emotional symptoms like anxiety and depression 4
• Vestibular-ocular dysfunction evaluation and management, as this is a common issue in PCS patients 4
• Sleep management, as sleep disturbances are frequent in PCS 3

Approach to Management

The approach to managing PCS should be holistic, considering the physical, cognitive, emotional, and sleep aspects of the patient's condition. It is crucial to:

• Adopt a hierarchic, sequential approach to managing treatable symptoms that impact functioning 3
• Consider the risk factors for the development of late-phase disorders, such as high early symptom burden, history of multiple concussions, psychiatric conditions, and younger age 3
• Recognize that rest has traditionally been a mainstay of treatment but that active rehabilitation, including guided physical activity, can be beneficial for recovery 6, 5