Best Medication for Concussion-Related Headache
Non-steroidal anti-inflammatory drugs (NSAIDs), particularly ibuprofen, are the first-line treatment for headaches resulting from concussion. These medications provide effective pain relief while minimizing the risk of medication overuse headaches.
First-Line Treatment Options
- Ibuprofen (400-800 mg every 6 hours) is recommended as the first-line treatment for concussion-related headaches due to its effectiveness in reducing pain and inflammation 1, 2
- Naproxen sodium (275-550 mg every 2-6 hours) is an alternative NSAID option with longer duration of action 1
- Aspirin (650-1000 mg every 4-6 hours) may be effective but should be avoided in children and adolescents due to risk of Reye's syndrome 1, 3
Second-Line Treatment Options
- Acetaminophen (1000 mg) can be used for patients who cannot tolerate NSAIDs, though it's generally less effective when used alone 1, 4
- Combination therapy of acetaminophen plus ibuprofen may provide better relief than either medication alone in some cases 2
- Aspirin-acetaminophen-caffeine combination is strongly recommended for migraine-like post-concussion headaches 1
Treatment Considerations
- Begin treatment early in the headache phase for maximum effectiveness 1
- Limit use of acute headache medications to no more than twice weekly to prevent medication overuse headaches 1, 5
- Avoid opioids and barbiturates for concussion-related headaches as they can lead to dependency, rebound headaches, and loss of efficacy 1
Special Populations
- For patients with nausea or vomiting, consider antiemetics such as metoclopramide as adjunctive therapy 1
- For patients with contraindications to NSAIDs (such as gastric ulcers, bleeding disorders, or kidney disease), acetaminophen is a safer alternative 1, 6
Monitoring and Follow-up
- Monitor for symptom improvement within 1-2 hours of medication administration 1
- If headaches persist beyond 7 days despite appropriate analgesic use, further evaluation may be warranted 5
- Be cautious about long-term medication use, as early analgesic administration has not been shown to decrease risk of headache at 7 days post-concussion 5
Common Pitfalls to Avoid
- Using acetaminophen alone as first-line therapy (less effective than NSAIDs for this indication) 1, 4
- Overusing medications, which can lead to medication overuse headaches 1, 5
- Using opioids or barbiturates, which carry significant risks of dependency and rebound headaches 1
- Failing to address associated symptoms such as nausea that may accompany post-concussion headaches 1