From the Guidelines
Treatment for persistent post-concussive symptoms lasting over a year typically involves a multidisciplinary approach tailored to specific symptoms, with a focus on nonpharmacological interventions as recommended by recent guidelines 1. For cognitive fatigue, a combination of cognitive rehabilitation therapy and gradual return to activities with scheduled rest periods is recommended. Medications that may help include methylphenidate (Ritalin) at 5-10mg twice daily or modafinil (Provigil) at 100-200mg daily to improve attention and reduce fatigue. For mood changes, selective serotonin reuptake inhibitors like sertraline (Zoloft) starting at 25-50mg daily or cognitive behavioral therapy (CBT) with 8-12 weekly sessions can be effective. Some key symptoms that may persist one year after a concussion include:
- Cognitive fatigue
- Mood changes
- Sleep disturbances
- Headaches
- Balance issues Physical therapy focusing on vestibular rehabilitation may help with balance issues, while headaches might respond to amitriptyline (10-25mg at bedtime) or topiramate (25-100mg daily). Sleep hygiene practices and sometimes low-dose melatonin (1-3mg before bed) can address sleep disturbances. These treatments work by targeting the neurochemical imbalances and neural pathway disruptions caused by the initial trauma. Regular follow-up with healthcare providers is essential to monitor progress and adjust treatments as needed, as recovery from persistent symptoms requires ongoing management and patience, as supported by recent studies 1.
From the Research
Persistent Post-Concussive Symptoms
- Cognitive fatigue and mood changes are common symptoms that can persist over 1 year after a concussion 2, 3
- These symptoms can significantly impact an individual's ability to return to work and daily activities 2
Treatment Options
- Methylphenidate has been shown to be effective in reducing mental fatigue and improving cognitive function in individuals with persistent post-concussive symptoms 2, 3, 4
- Selective serotonin reuptake inhibitors, such as sertraline, may be effective in treating post-injury depression 3
- Amantadine has been shown to be effective in reducing symptoms and improving neurocognitive performance in adolescents with sports-related concussion 5
- Galantamine may also be a potential treatment option, although more research is needed to confirm its effectiveness 6
Key Findings
- Methylphenidate treatment has been associated with significant improvements in mental fatigue, depression, and anxiety, as well as cognitive function, in individuals with persistent post-concussive symptoms 2, 4
- The effects of methylphenidate treatment can be reversible if discontinued, highlighting the need for ongoing treatment to maintain improvements 4
- Further research is needed to fully understand the efficacy and safety of these treatment options and to guide clinical decision-making 3, 6