An extremely complicated topic, partly because of potential for litigation and the fact that symptoms are often vague and nonspecific and there may be no objective findings to corroborate subjective symptoms.
Most symptoms from concussion resolve within 7–10 days and do not require treatment. The most common exception to this is posttraumatic headache, the most common subtype being acute posttraumatic migraine.
Typical symptoms include: H/A, dizziness, insomnia, exercise intolerance, depression, irritability, anxiety, memory loss, difficulty concentrating, fatigue, light or noise hypersensitivity.
Patients with protracted symptoms may require more directed treatment.
● Psychological and neuropsychological involvement is often employed
● Pharmacologic treatment: there are no evidence-based studies of the utility of medications for post-concussive symptoms (aside from H/A)
● Intractable headaches: occurs in ≈ 15% of concussions
○ Expert neurology consultation is usually required for difficult-to-control headaches
○ The first line drugs are OTC medications
○ Triptans are usually employed for nonresponders
○ Third line drugs includ Ketorolac or DHE-45 (dihydroergotamine)
○ Steroids may be beneficial for some
○ Avoid: narcotics, butalbital/caffeine preparations (Fioricet, Esgic…), beta blockers, and calcium channel blockers