Concussion Treatments and Medications

Although called a "mild" traumatic brain injury, concussions should be taken seriously. Happily, most concussions fully resolve in a few weeks, and life returns to normal. But not always. Even though a concussion isn't physically visible, it's a serious injury. Knowing what a concussion is and what needs to be done in the days and weeks following the injury makes the difference in whether symptoms go away in a few weeks or persist for months or years.

What is a concussion?

A concussion is a mild traumatic brain injury (TBI) that disrupts brain function. A blow to the head, whiplash, or anything that causes the head to jerk can cause a concussion.

The exact mechanism of concussions is not well understood. A concussion may or may not involve actual physical damage to the brain tissues. Instead, the injury involves physiological and biochemical disruptions in brain function. It produces all the classic symptoms of a concussion, such as a headache, disorientation, memory loss, and even loss of consciousness.

The Centers for Disease Control and Prevention (CDC) estimates that 1.4 to 3.8 million people in the U.S. have a concussion every year. Car accidents, falls, assaults, blows to the head, and sports injuries are the most common causes of concussions.

Although sports injuries make up only a small percentage of concussions, athletes, particularly those in contact sports (especially those that do not require protective headgear), are more at risk for concussion than others. Younger people are more vulnerable than adults. Women may be more vulnerable than men and require more time to recover.

People with previous concussions are considerably more susceptible to a second concussion, which is usually more severe and requires a longer recovery. This heightened vulnerability could linger for months or years. If symptoms from the first concussion have not resolved, a second concussion can sometimes lead to second impact syndrome (SIS)—rare but serious brain damage that could be lethal.

Even though most concussions are mild and quickly resolved, other outcomes are possible depending on the severity of brain trauma and how well the concussion heals.

• Acute concussion: In most people, almost all the concussion symptoms will resolve in two to four weeks.

• Post-concussion syndrome: About 10% to 15% of people who have a concussion will continue to experience concussion symptoms for months or even years after the injury.

• Second-impact syndrome: In rare cases, a second impact before a concussion has healed may cause the brain to swell, a potentially life-threatening condition. Brain swelling may happen days after the concussion, even without a second impact in more exceptional cases.

• Post-traumatic epilepsy: Seizures may follow a concussion in the weeks following the head trauma. The risk for seizures is related to the severity of the injury and how well the concussion has healed.

• Mental illness: Repeat concussions may eventually produce personality changes, depression, or anxiety, depending on the severity of the injuries.

• Chronic traumatic encephalopathy: A long history of repeat concussions can eventually result in progressive brain degeneration with symptoms similar to Alzheimer's or Parkinson's disease.

How is a concussion diagnosed?

The diagnosis of concussion is clinical. The healthcare provider will look for symptoms or signs of a concussion, determine how the injury happened, how long it took for symptoms to appear, any history of previous concussions, and how long the symptoms have lasted.

The doctor will perform a thorough exam that includes a neurological workup, a cognition evaluation, and a determination of any emotional changes. They also will assess for more severe brain injury, neck injury, or skull fracture, all of which are risks.

The doctor will not need blood tests or imaging, such as a CT scan unless there is a more severe injury.

However, people must know concussion symptoms so that they can get medical care if they or another person appears to be concussed. A concussion can disrupt the physical, cognitive, emotional, and sleep functions.

The most common symptoms of concussion are:

Physical concussion symptoms

• Headache

• Dizziness

• Balance problems

• Loss of coordination

• Vision problems

Cognitive concussion symptoms

• Confusion

• Disorientation

• Fogginess

• Loss of memory

• Inability to concentrate

Emotional concussion symptoms

• Irritability

• Mood changes

Sleep problems

• Drowsiness

• Sleeping less or more than usual

• Difficulty falling asleep

Coaches, athletes, and parents should be familiar with concussion assessment tools such as the Sports Concussion Assessment Tool 5 (SCAT5) or the Child SCAT5.

Concussions are graded as mild, moderate, or severe. Mild, or grade 1 concussions have symptoms that resolve in less than 15 minutes. Moderate or grade 2 concussions have symptoms that hang on for longer than 15 minutes. Losing consciousness for any amount of time automatically moves the injury into a grade 3 or severe concussion.

The ever-present danger of a concussion is that the problem may be more severe, such as bleeding in the brain (hematoma), or involve other potentially serious injuries, such as neck injury or a skull fracture.

The danger signs of concussion indicating that emergency medical care is needed are:

• Neck pain or tenderness

• One pupil larger than another

• Double vision

• Slurred speech

• Sleepiness or an inability to be awakened

• Weakness, tingling, or burning in the legs or arms

• Severe headache or increasingly severe headache

• Seizure or convulsions

• Deteriorating conscious state or mental abilities

• Loss of consciousness, even briefly

• Repeated vomiting

• Unusual behavior, restlessness, agitation, or combativeness

RELATED: Urgent care vs. emergency room visits

Concussion treatment options

Concussions resolve themselves in days or weeks, depending on the severity of the injury. Most people can expect to be 90% recovered in three or four weeks after the injury. The most important treatment is rest and a gradual return to physical and mental activity.

In the days following a concussion, headaches are the most common and often the most debilitating symptom. They can persist for several months after the injury. More than 50% of patients who have headaches after a concussion continue to have headaches up to a year later.

Dizziness is also very common and can persist for a while. About 8 in 10 patients will experience dizziness in the days following a concussion. Finally, most people with concussions will experience problems with sleeping. These symptoms, too, may persist for weeks.

Rest

The gold standard treatment for a concussion is rest from both mental and physical activity. There is no agreement as to how much rest is needed. Too much rest may actually prolong the symptoms.

As a good rule of thumb, the initial rest period should be 24 to 48 hours. As the symptoms subside, patients can gradually resume normal physical and mental activities. Most patients will follow a predetermined set of steps in which they steadily progress back to their normal lives.

Concussion medications

There are no medications that treat concussion or post-concussion syndrome. Medicines may treat symptoms such as headaches or nausea. However, in the first four hours after the injury, bleeding in the brain is a serious risk, so NSAIDs, such as aspirin or ibuprofen, should be avoided. The safest pain medication in the hours or days after a concussion is acetaminophen.

In general, though, health professionals tend to avoid medications during the recovery period. Concussion deranges brain function. It's generally believed that avoiding medications helps the healing process following a head injury. Doctors are in agreement, however, that acetaminophen and drugs to treat dizziness and nausea are useful and don't interfere with the healing process.

Post-concussion syndrome

Most patients (85%-90%) fully recover in a few weeks. In others, however, some or all the symptoms persist. Called post-concussion or post-concussive syndrome, this condition of persisting concussion symptoms will require additional treatment.

Medications can help specific post-concussion syndrome symptoms such as headaches, tension headaches, nausea, dizziness, sleep problems, lack of energy, blood pressure dysregulation, and others.

Cognitive therapy, occupational therapy, sensory-motor therapies, neuromuscular rehabilitation, exercise therapy, and cognitive behavioral therapy can target particular problems and resolve them in support of or in place of medications.

Concussion medications

No medication cures a concussion or expedites recovery. The primary treatment is time and rest. However, many of the symptoms of concussions are treatable with medications.

Pain relievers

The most common concussion symptom is headache, which can be mild, severe, or similar to a tension headache or migraine. Headaches may persist for months after the injury.

In the hours and days following a concussion, over-the-counter acetaminophen is the recommended pain reliever. NSAIDs, such as aspirin and ibuprofen, can cause bleeding problems, and one of the most pressing concerns of a concussion is bleeding in the brain.

Post-concussion syndrome headaches are treatable with over-the-counter or prescription NSAIDs. Opioids, such as tramadol, are rarely used.

Vestibular suppressants

Next to headaches, dizziness and nausea are the most common concussion symptoms. They are both caused by the same mechanism and can be treated with motion sickness drugs (vestibular suppressants), such as antihistamines (over-the-counter Dramamine) or anticholinergics (Scopolamine). These drugs reduce the brain's sensitivity to movement in the inner ear (vestibule) that causes dizziness and nausea after a concussion.

Antidepressants

The next most common symptoms are sleep problems and mood problems. Behavior changes and depression are much more common after a concussion than people realize. Tricyclic antidepressants, SSRIs (selective serotonin reuptake inhibitors), and SNRIs (serotonin and norepinephrine reuptake inhibitors) can alleviate sleep problems and mood problems.

Stimulants

To help with confusion, inattention, and concentration, a healthcare provider may prescribe a stimulant such as methylphenidate or dextroamphetamine.

Other medications

The brain is a complex organ. Damage done to the brain by a concussion can spawn any number of problems. Specialized medications are useful when these problems persist for weeks or months.

• Sleep medications: For post-concussion syndrome, the recommended sleep medications are antidepressants and trazodone. Benzodiazepines, antihistamines, and sedatives are generally not advised for sleep problems due to concussion.

• Anxiety medications: Anti-anxiety medications may relieve anxiety and sleep problems due to post-concussion syndrome. Benzodiazepines, such as Xanax, are generally not advised.

• Triptans: Triptans prevent tension headaches or migraines.

• Blood pressure medications: Blood pressure dysregulation sometimes occurs after a concussion and is controlled with blood pressure medications.

• Seizure medications: Post-traumatic epilepsy is treatable with seizure medications.

• Hormone medications: Concussions can sometimes damage the parts of the brain that regulate hormones—the pituitary gland and the hypothalamus. A doctor may prescribe hormone replacement medications or hormone inhibitors.

What are the best medications for a concussion?

No medication treats concussions. Sometimes, however, medications will be used to treat symptoms like headaches, dizziness, or nausea. For headache pain, the drug of choice is acetaminophen. A variety of medications may treat post-concussion syndrome, depending on the symptoms.

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Best medications for a concussion