After covering introduction , imaging and treatment strategies of persistent post-concussive symptoms (PPCS), also termed post-concussion syndrome, we continue by examining the evidence behind commonly used...
After covering introduction , imaging and treatment strategies of persistent post-concussive symptoms (PPCS), also termed post-concussion syndrome, we continue by examining the evidence behind commonly used pharmacologic agents. There are some providers that manage concussions without prescribing any medications and only recommend over-the-counter acetaminophen or ibuprofen. Other providers may try to treat symptoms of concussion with pharmacologic agents.
Management likely depends on how many concussions the individual sees, treatment options available and region of practice. It is important to note that there is still no medications that is FDA approved to specifically treat persistent post-concussion symptoms. Many of the medications used are off label and approved for other conditions and some medications used require close monitoring and follow up.
Attempts should be made to wean patients off of any medications used to treat PPCS symptoms after they have recovered.A 2013 survey reported that 89% of 220 providers managing pediatric concussions reported the majority manage symptoms with medications with acetaminophen most common (62%), followed by NSAIDs (54%). The next most commonly prescribed medications were tricyclic antidepressants (23%), amantadine (10%) and methylphenidate (10%). It was also more common for providers to use these types of medications if they see more than 16 concussions per year.
The most recent position statement from AMSSM breaks down post-concussive symptoms into vestibular, ocular, cognitive, fatigue, anxiety/mood and headache/migraine. The vestibular and ocular categories were previously covered. The other symptoms are more likely to be treated pharmacologically.
Headaches are the most common symptom associated with concussions and many providers will treat post concussive headaches with medications besides acetaminophen or NSAIDs. Headaches related to concussions are sometimes separated into tension-type headaches and migraine-type headaches. Tricyclic antidepressants, such as amitriptyline and nortriptyline, are commonly used.
If you are experiencing symptoms that may be related to persistent post-concussive symptoms: pharmacology, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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