Is Flexeril (cyclobenzaprine) safe to give to someone with a concussion?

Cyclobenzaprine Should Be Avoided in Concussion Patients

Cyclobenzaprine (Flexeril) should not be given to someone with a concussion, as muscle relaxants are not indicated for concussion management and may interfere with neurological assessment and recovery.

Why Cyclobenzaprine Is Contraindicated

Medication Restrictions After Concussion

• The National Athletic Trainers' Association explicitly recommends that athletes with concussion should avoid taking medications except acetaminophen, and even acetaminophen should only be given at the recommendation of a physician 1
• Patients should avoid any substances that might interfere with cognitive function and neurological recovery 1
• Cyclobenzaprine is a centrally acting muscle relaxant that causes significant CNS depression, with drowsiness and sedation occurring in over 30% of patients 2

Mechanism of Action Creates Problems

• Cyclobenzaprine works centrally via inhibition of tonic somatic motor function through modulation of noradrenergic and serotonergic systems 2
• It is a potent non-competitive antagonist of histamine H1 receptors in the brain, which directly causes sedation 2
• The drug readily crosses the blood-brain barrier and exerts its effects centrally 2
• These CNS effects would mask or confound the neurological monitoring essential in concussion management 1

Interference with Recovery Assessment

• The American Academy of Pediatrics states that continued medication use to control concussion symptoms indicates incomplete recovery 3
• Before considering return to activities, medications used to reduce symptoms must be stopped and the patient must remain symptom-free off medication 3
• Cyclobenzaprine's sedative effects would make it impossible to accurately assess whether concussion symptoms have resolved or are simply being masked 3

Appropriate Concussion Management

First-Line Medication Approach

• Acetaminophen may be considered as first-line treatment for painful headaches after concussion, though there is no evidence it shortens recovery 3
• NSAIDs (including ibuprofen) should be avoided immediately after suspected head injury due to theoretical risk of intracranial bleeding 3
• Animal studies found chronic ibuprofen administration worsened cognitive outcomes after traumatic brain injury 3

Non-Pharmacological Management Is Primary

• Cognitive rest is essential, including temporary leave from school/work, shortened days, reduced workloads, and extra time for assignments 3
• Physical rest should be implemented until symptoms resolve 3
• Avoid activities requiring concentration including video games, computer use, and television 3

Critical Pitfall to Avoid

The most dangerous mistake would be giving cyclobenzaprine to manage neck muscle spasm or tension headache in a concussion patient, as the resulting sedation would:

• Prevent accurate neurological assessment 1
• Mask deteriorating mental status that could indicate worsening brain injury 1
• Interfere with the patient's ability to report symptom changes 3
• Create withdrawal symptoms requiring 2-3 week taper if used long-term 3