“What medication should I take after a concussion?”, is possibly not the correct question to ask.
A better question would be “Should I take any medication after a concussion?”
Even then, to answer the question we need to separate the issues of the acute period, say in the first two to four weeks after a concussion episode, from the more chronic presentation when symptoms continue for longer than a few months.
In the acute phase, symptoms such as headache, dizziness or nausea can be strong and debilitating leading to some to seek a script from the doctor for some relief. In the more chronic phases, the frustration of ongoing symptoms and feeling medications might be the cure can also be the driver for medications. Let’s look at what are the important issues for medication use after a concussion.
The Acute Phase
A recent review of the literature on medication use in the acute phase of concussion was reported on in the Journal of the American Medical association (JAMA Neurology). They reviewed nearly 1400 research articles and concluded that:
‘This systematic review found a limited number of high-quality, clinically meaningful studies, particularly among children and individuals in the acute stage of injury; therefore, performing an evidence-based analysis that would inform clinical decision-making was not possible.’
In other words, there is not much evidence to support the use of medications in the acute phase of concussion. This is consistent with the Berlin Consensus Statement on sports concussion which concludes the same thing.
What normally happens is, if you go and see a doctor, they will suggest taking some Panadol or Nurofen to ease any pain or discomfort, usually headache-related, in the first few days after the concussion event. These medications can ‘mask’ the symptoms but don’t actually promote any healing in the brain. As much of the rehabilitation from your concussion injury is controlled by your symptom presentation it is important not to mask your symptoms by taking pain-relieving medication for long periods of time or taking too much.
Recommendation 1
If you are still relying on regular medication to get you through the day, three to four days after your concussion, review with your GP to make sure there is nothing sinister going on. Further tests may need to be carried out.
It will also be worthwhile to see a concussion practitioner to start a rehabilitation program, which should help reduce your symptoms.
The Chronic Phase
Ongoing symptoms that last for more than six to eight weeks after a concussion are usually referred to as PCS (Persistent Concussion Symptoms). In these chronic phases of concussion, symptoms might be less intense but more frustrating because they have been continuing for an extended period of time. Hence, just getting some relief from the symptoms can be a huge driver for using medications.
The range of issues in PCS can be quite varied so therefore a range of different medications are often used to give some relief. As with the acute phase, these medications will often just mask the symptoms which can make rehabilitation more difficult. The worst-case scenario is that these medications can sometimes have some other side effects which mimic other concussion symptoms. For example, some medications for dizziness may cause nausea.
Recommendation 2
If you are not doing a serious rehabilitation program for your concussion injury and just using medications to get you through the day, you are not setting yourself up for a good recovery.
Start a rehabilitation program with someone who can guide you through aerobic exercise, a visual/balance program, neck treatment, dietary changes and psychological support. You may need a change of mindset and pull back from other activities to be focused on recovery. This will get you a better long-term recovery.
Recommendation 3
There are occasions where medication is required to help act as a ‘circuit breaker’ to settle symptoms and allow the rehabilitation program to continue more effectively. The healthcare professionals involved in the rehabilitation and medication side of your treatment should be in communication on this process to make effective choices on the best way forward. For example, medications that make you sleepy or fatigued may not be the best choice if you are attempting to exercise on a regular basis.
In summary, it is most appropriate to see medication as a short term help, not a long term solution.
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