From the Guidelines
For a patient experiencing headaches and dizziness 2 weeks post-concussion, the recommended treatment includes a gradual return to activities while avoiding symptom triggers, along with consideration of graded physical exercise and vestibular rehabilitation. The treatment approach should prioritize symptom management and promote recovery by allowing the brain to heal while gradually reintroducing normal activities. According to the most recent and highest quality study 1, graded physical exercise and vestibular rehabilitation are recommended for patients with persistent postconcussive symptoms. Key components of the treatment plan include:
- Gradual return to activities while avoiding symptom triggers
- Consideration of graded physical exercise, as defined by the intervention of physical exercise with a gradual increase in intensity and/or complexity over time 1
- Vestibular rehabilitation, including otolith manipulating procedures, habituation and adaptation exercises, substitution training, and balance training, for patients with persistent vestibular dysfunction after concussion 1
- Avoidance of nonsteroidal anti-inflammatory drugs like ibuprofen in the acute phase, as there is no evidence demonstrating their efficacy in alleviating symptoms or shortening the course of concussion 1
- Acetaminophen (Tylenol) 500-1000mg every 6 hours as needed for headache pain may be considered, although the evidence is limited 1
- Adequate hydration, regular sleep patterns, and stress management are also beneficial for overall recovery. If symptoms persist beyond 4 weeks or worsen, the patient should seek follow-up care as they may need specialized evaluation from a neurologist or concussion specialist, emphasizing the importance of active management and treatment of persistent postconcussion symptoms 1.
From the Research
Treatment Options for Post-Concussion Symptoms
The patient is experiencing headaches and dizziness 2 weeks post-concussion. The recommended treatment options for post-concussion symptoms include:
- Sub-symptom threshold aerobic exercise 2
- Cervical physical therapy 2
- Vestibular therapy 2, 3
- Vision therapy 2
- Cognitive rehabilitation 2
- Cognitive behavioral therapy 2, 4
- Pharmacological management 2, 5
- A combination of treatments 2
Vestibular Rehabilitation
Vestibular rehabilitation can be an effective modality in treating dizziness, vertigo, and imbalance following concussion 3. The clinician must have a solid understanding of when and why certain exercises are required, and be willing to accept that less exercise may be indicated in this population 3.
Active Rehabilitation
Active rehabilitation of concussion and post-concussion syndrome can include physical, cognitive, and emotional therapies 6. Rest has been the mainstay of treatment for concussion and post-concussion syndrome, but active treatment can be beneficial in some cases 6.
Behavioral Therapies and Mind-Body Interventions
Behavioral therapies and mind-body interventions, such as cognitive behavioral therapy and relaxation, can be effective in treating post-traumatic headache and post-concussive symptoms 4. However, the heterogeneity of studies makes it difficult to fully assess efficacy 4.
Physical Activity and Intermittent Postconcussion Symptoms
Physical activity can be beneficial in reducing intermittent postconcussion symptoms, but the optimal timing and intensity of physical activity are unclear 5. Patients with cervical spine or vestibular dysfunction may benefit from rehabilitation techniques targeted at their individual symptom profile to facilitate recovery 5.