What medications are helpful for controlling symptoms of mild traumatic brain injury (mTBI) or concussion?

From the Guidelines

Several medications can help manage concussion symptoms, but the most effective approach is often a combination of rest, gradual return to activities, and targeted pharmacological interventions. For headaches, over-the-counter pain relievers like acetaminophen (Tylenol) are generally recommended, with a typical adult dose of 650-1000mg every 6 hours, not exceeding 4000mg daily 1. NSAIDs such as ibuprofen (Advil, Motrin) or naproxen should be avoided in the first few days after injury due to bleeding risk, but may be used later for pain and inflammation at doses of 400-600mg every 6-8 hours for ibuprofen or 220-440mg twice daily for naproxen 1. Some studies suggest that medications like candesartan or telmisartan may be helpful in preventing episodic migraine, which can be a symptom of concussion 1. Additionally, medications like erenumab, fremanezumab, or galcanezumab may be recommended for the prevention of episodic or chronic migraine 1. For sleep disturbances, melatonin (3-10mg before bedtime) may help regulate sleep patterns. Nausea can be treated with antiemetics like ondansetron (Zofran) 4-8mg every 8 hours as needed. For persistent symptoms, a healthcare provider might prescribe amitriptyline or nortriptyline for headaches (starting at 10-25mg nightly), or specific medications for vertigo or anxiety. It's essential to use medications only as directed and consult a healthcare provider, especially for symptoms lasting more than 10-14 days, as they can recommend appropriate dosing and monitor for side effects 1.

Some key points to consider when managing concussion symptoms include:

• Rest and gradual return to activities are crucial for recovery
• Medications should be used to target specific symptoms, such as headaches or sleep disturbances
• Healthcare providers should be consulted to recommend appropriate dosing and monitor for side effects
• A combination of pharmacological and non-pharmacological interventions may be necessary to manage persistent symptoms.

It's also important to note that the evidence for the effectiveness of medications in managing concussion symptoms is limited, and more research is needed to determine the best approaches for treatment 1. However, based on the available evidence, a comprehensive approach that includes rest, gradual return to activities, and targeted pharmacological interventions is likely to be the most effective way to manage concussion symptoms and improve outcomes.

From the Research

Medications for Controlling Symptoms of Mild Traumatic Brain Injury (mTBI) or Concussion

• The medications used in post-concussion syndrome are typically used to help manage or minimize disruptive symptoms while recovery proceeds 2.
• There are currently no FDA-approved medications for treatment of cognitive and neuropsychiatric problems in the context of mild TBI, yet a number of agents are prescribed "off-label" for these complaints 3.
• The literature supports the use of neurostimulant methylphenidate for treatment of mild TBI-related cognitive dysfunction, and the selective serotonin reuptake inhibitor, sertraline, for the treatment of post-injury depression 3.

Treatment Options

• Treatment options for concussion and persistent post-concussive symptoms (PPCS) include sub-symptom threshold aerobic exercise, cervical physical therapy, vestibular therapy, vision therapy, cognitive rehabilitation, cognitive behavioral therapy, pharmacological management, or a combination of treatments 4, 5.
• Medications and supplements remain a small part of the concussion treatment plan, which may include temporary academic adjustments, physical therapy, vestibular and ocular therapy, psychological support, and graded noncontact exercise 2.

Approach to Medication

• Without clear guidance from the literature, a cautious approach of starting low and titrating slowly is recommended when prescribing medications for mTBI or concussion 3.
• Treatment for concussion and PPCS should be individualized, based on predominant signs and symptoms, and can include symptom-specific pharmacological therapies 5.