From the Guidelines
Active management and treatment of Post-Concussive Syndrome (PCS) through individual disciplines targeting specific problems and interdisciplinary rehabilitation is recommended. To help a person recover from PCS, a multifaceted approach is necessary, focusing on nonpharmacological treatments as the primary intervention [ 1 ]. This approach includes individual disciplines such as physical therapy, cognitive rehabilitation therapy, and psychological support.
Key Components of Treatment
- Physical therapy, specifically vestibular rehabilitation, can help with balance and dizziness issues [ 1 ].
- Cognitive rehabilitation therapy addresses memory and concentration problems.
- Psychological support through cognitive behavioral therapy (CBT) helps manage anxiety and depression that often accompany PCS.
- Lifestyle modifications are crucial, including maintaining regular sleep schedules, avoiding alcohol and caffeine, staying hydrated, and eating nutritious meals.
Importance of Interdisciplinary Rehabilitation
Given the complexity of PCS, interdisciplinary rehabilitation is essential for comprehensive management, as it allows for the coordination of care across different disciplines, ensuring that all aspects of the condition are addressed [ 1 ]. This approach is supported by the best available evidence to date and is recommended across various guidelines.
Gradual Return to Activities
A gradual return to normal activities as symptoms improve is vital, allowing the brain to heal and reducing the risk of exacerbating symptoms. This may involve a gradual exercise program, starting with short periods of light activity and slowly increasing as tolerated.
Medications and Supplements
While nonpharmacological treatments are the primary focus, medications such as acetaminophen for headaches and amitriptyline for persistent headaches or sleep disturbances may be considered on a case-by-case basis, under the guidance of a healthcare provider. However, the use of medications should be carefully evaluated and monitored due to potential side effects and interactions [ 1 ].
From the Research
Treatments for Post-Concussive Syndrome (PCS)
- The management of Post-Concussive Syndrome (PCS) involves a multidisciplinary approach, including therapeutic education, physical and cognitive rehabilitation, and psychological care 2.
- Therapeutic education intervention within 3 months after mild Traumatic Brain Injury (mTBI) has been found to be effective in preventing post-concussion syndrome 2.
- For physical disabilities, several pharmacological, rehabilitative, and non-pharmacological techniques have shown efficacy in reducing headache and vertigo, with repetitive Transcranial Magnetic Stimulation (rTMS) also showing promise 2.
- The management of fatigue requires a multidisciplinary approach, and rehabilitation and brain-stimulation techniques have proven effective in reducing cognitive impairment 2.
- Cognitive and Behavioral Therapy interventions are the most frequently reported psychological care approaches for patients with PCS, followed by psychoeducational interventions 2.
- Post-Traumatic Stress Disorder (PTSD) management is crucial in the overall recovery of patients with PCS 2, 3.
Medical Therapies for Concussion
- Medications used in post-concussion syndrome are typically used to manage or minimize disruptive symptoms while recovery proceeds, and are not routinely used in most concussions that recover within days to weeks 4.
- 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 non-contact exercise 4.
- A guided prescription of aerobic exercise is beneficial for early- and late-phase disorders after concussion 5.
Rehabilitation Techniques
- Various rehabilitation techniques, including cognitive rehabilitation programs, technology-assisted rehabilitation, different types of brain stimulation, and pharmacological treatments, have been studied for their effectiveness in managing PCS 2, 3, 6.
- Sub-symptom threshold aerobic exercise, cervical physical therapy, vestibular therapy, vision therapy, cognitive rehabilitation, and cognitive behavioral therapy are evidence-based treatments for post-concussion symptom generators 3.
- Treatment should include a hierarchic, sequential approach to management of treatable symptoms that impact functioning, such as depression, anxiety, insomnia, headache, musculoskeletal pain, and vertigo 5.