Medication Management After Concussion
Medications are generally not recommended for routine use after a concussion, with cognitive and physical rest being the primary treatment approach. 1
Acute Post-Concussion Headache Management
- Acetaminophen may be considered as a first-line treatment for painful headaches after concussion, but there is no evidence demonstrating efficacy in shortening the course of concussion recovery 1
- NSAIDs (including ibuprofen) should be avoided immediately after a suspected head injury due to the theoretical risk of intracranial bleeding, although no studies have documented actual harm from NSAID use after sport-related concussion 1
- In one animal study, chronic administration of ibuprofen was found to worsen cognitive outcomes after traumatic brain injury, raising additional concerns about NSAID use 1
- Opioids are not recommended for post-concussion headache management due to risk of dependence and lack of efficacy 2
Medication Considerations for Persistent Symptoms
For Prolonged Headaches
- For patients with persistent headache symptoms (lasting beyond the acute phase), medication may be considered for symptom management 1
- A pilot study showed that routine administration of acetaminophen or ibuprofen (after the acute phase) may be effective for post-concussive headache management 3
- Patients using both acetaminophen and ibuprofen (79%) or ibuprofen alone (61%) were more likely to return to school within one week compared to acetaminophen alone (33.3%) or standard care (21.1%) 3
For Central Post-Stroke Pain (if applicable)
- For patients who develop central pain after brain injury:
- Anticonvulsants (gabapentin or pregabalin) should be used as first-line treatment 1
- Tricyclic antidepressants (e.g., amitriptyline) or SNRIs (particularly duloxetine) should be used as second-line treatment 1
- Opioids should be considered only for patients resistant to first and second-line treatments, with caution due to risk of dependency 1
Important Considerations and Pitfalls
- Continued medication use to control concussion symptoms indicates incomplete recovery; before considering return to play/activities, medications used to reduce symptoms must be stopped and the patient must remain symptom-free off medication 1
- Analgesic overuse can lead to rebound headaches, making symptoms worse in the long term 2, 4
- Most individuals with post-concussion headaches self-treat with over-the-counter medications, but these provide effective relief for only a minority of patients 4
- Despite many post-concussion headaches meeting criteria for migraine/probable migraine, only 8% of those patients use triptans, suggesting potential undertreatment of specific headache types 4
Non-Pharmacological Approaches (Priority)
- Cognitive rest is essential and includes:
- Temporary leave of absence from school/work
- Shortened school/work days
- Reduced workloads
- Extra time for assignments/tests 1
- Physical rest should be implemented until symptoms resolve 1
- Avoid activities requiring concentration and attention, including:
- Video games
- Computer use
- Television viewing 1
- For patients with photophobia, sunglasses may be considered 1
- For patients with phonophobia, avoid loud music and headphones 1
Remember that the primary goal of concussion management is to hasten recovery by ensuring the patient avoids activities that may slow recovery, with medications playing a limited role in the overall treatment approach 1.