What are the treatment options for nausea in post-concussive syndrome (PCS)?

From the Guidelines

Nausea in post-concussive syndrome (PCS) should be primarily managed with nonpharmacological treatments, emphasizing active management and interdisciplinary rehabilitation, as recommended by the most recent and highest quality evidence 1. When considering treatment options for nausea in PCS, it's essential to prioritize approaches that address the overall symptom complex and promote recovery.

• Nonpharmacological interventions, such as maintaining proper hydration, eating small frequent meals, avoiding triggers, and getting adequate rest, are crucial in managing nausea.
• Interdisciplinary rehabilitation, including vestibular rehabilitation therapy if nausea is related to vestibular dysfunction, can be highly beneficial in addressing the multifaceted nature of PCS symptoms.
• While medication may be considered for immediate relief, such as antiemetic medications, the focus should be on nonpharmacological methods to minimize potential side effects and promote long-term recovery.
• The current evidence base, as highlighted by the systematic review and meta-analysis 1, underscores the importance of a comprehensive and multidisciplinary approach to treating PCS symptoms, including nausea.
• Individualized treatment plans should be developed based on symptom severity, other post-concussive symptoms, and patient tolerability, ensuring that the management of nausea is integrated into the broader care strategy for PCS.

From the Research

Treatment Options for Nausea in Post-Concussive Syndrome (PCS)

• The provided studies do not specifically address treatment options for nausea in post-concussive syndrome (PCS) 2, 3, 4, 5, 6.
• However, some studies mention treatment options for symptoms that may be related to nausea, such as headache, vertigo, and fatigue 2, 3, 4, 5.
• Treatment options for post-concussive syndrome (PCS) in general include:
  • Sub-symptom threshold aerobic exercise 3, 5
  • Cervical physical therapy 3, 5
  • Vestibular therapy 3
  • Vision therapy 3
  • Cognitive rehabilitation 2, 3, 5
  • Cognitive behavioral therapy 2, 3, 5
  • Pharmacological management 3, 6
• Some studies also mention the use of pharmacological agents such as fluoxetine and antioxidants like ascorbic acid, but the evidence is inconsistent and more research is needed to determine their effectiveness 6.