What is the treatment for a moderate headache in a 15-year-old with a mild concussion that occurred an hour ago?

Management of Moderate Headache in a 15-Year-Old with Recent Mild Concussion

Acetaminophen (1000 mg) should be used as the first-line treatment for moderate headache in this 15-year-old with a recent mild concussion. 1

Immediate Management Algorithm

1. First-line medication (0-48 hours post-concussion)

   • Acetaminophen 650-1000 mg (based on weight) 1, 2
   • Avoid NSAIDs in the first 48 hours due to potential bleeding risk 1

2. After 48 hours if headache persists

   • Can introduce ibuprofen 400-600 mg if acetaminophen is ineffective 1
   • Continue to monitor for symptom changes

3. Non-pharmacological interventions

   • Relative rest for 24-48 hours (avoiding activities that worsen symptoms) 1
   • Begin gradual light aerobic exercise after 24-48 hours of relative rest 3, 1
   • Ensure adequate hydration and regular sleep schedule

Important Considerations

Avoid These Common Pitfalls

• Do not prescribe opioids - These should be avoided due to high risk of dependency and rebound headaches 3, 1
• Do not recommend strict bed rest - Evidence shows detrimental effects from strict rest 3
• Do not allow high-intensity physical activity - This can worsen symptoms 3
• Do not overuse analgesics - Limit use to ≤15 days/month to prevent medication-overuse headache 1

Red Flags Requiring Immediate Medical Attention

Instruct the patient and family to return to medical care immediately if any of these develop:

• Worsening headache 3, 1
• Repeated vomiting 3
• Increasing confusion or memory problems 3
• Focal neurologic deficits 3
• Abnormal behavior 3
• Increased sleepiness 3
• Seizures 3

Return to Activity Protocol

After 24-48 hours of relative rest, implement a gradual return to activity following this 5-stage protocol 1:

1. Symptom-limited activity - Daily activities that don't provoke symptoms
2. Light aerobic exercise - Walking, swimming, stationary cycling at slow pace
3. Sport-specific exercise - Running drills, no head impact activities
4. Non-contact training drills - More complex training drills, progressive resistance training
5. Full-contact practice - Following medical clearance

Progress to the next stage only if asymptomatic at the current stage for at least 24 hours. If symptoms return, go back to the previous asymptomatic stage for at least 24 hours 1.

Follow-up Recommendations

• Schedule follow-up within 1-2 weeks to assess headache resolution
• If headaches persist beyond 3-4 weeks, consider referral to a concussion specialist 1
• Provide clear discharge instructions about warning signs and when to seek emergency care 3

This approach prioritizes symptom management while promoting appropriate recovery and preventing complications that could negatively impact morbidity, mortality, and quality of life in this adolescent with a mild concussion.