Medications for Concussion Symptoms - Introduction
Currently there is no medication designed specifically for concussions. Doctors typically will start talking to patients about medications when their concussion symptoms become persistent, for example, prescribing migraine medications for headache symptoms, SSRI's for depression symptoms, etc. Leading doctors in the field recommend that medication should not be prescribed in isolation, but with professional therapists (PT, OT) and lifestyle interventions. Some people are self-medicating with CBD oil from hemp or high CBD/low THC marijuana. Other patients are using over-the-counter medicine or caffeine in small doses for headaches. See below for further information.
Doctors may prescribe medications for symptoms such as pain, anxiety, insomnia, and depression. Dr. Chris Giza, Director of the Steve Tisch BrainSPORT Program at UCLA, recommends that concussion patients avoid taking medications that create problematic side effects, and that medications only be used in conjunction with professional therapies and lifestyle changes.
The medications doctors may prescribe migraine medications for headaches; SSRI (serotonin reuptake inhibitors) for depression; amitriptyline or trazadone for insomnia; and valproic acid or gabapentin for mood stabilization. See the chart on migraine medications at the bottom of this page.
The 2017 International Consensus on Concussion in Sport has this to say about medications for a concussion:
"Currently, there is limited evidence to support the use of pharmacotherapy. If pharmacotherapy is used, then an important consideration in return to sport is that concussed athletes should not only be free from concussion-related symptoms, but also should not be taking any pharmacological agents/medications that may mask or modify the symptoms of sport-related concussion. Where pharmacological therapy may be begun during the management of an sport-related concussion, the decision to return to play while still on such medication must be considered carefully by the treating clinician. Overall, these are difficult cases that should be managed in a multidisciplinary collaborative setting, by healthcare providers with experience in sport-related concussion."
There is concern about taking over-the-counter medications within a short time frame after a concussion because of the rare chance of bleeding in the brain. If you have a headache and you suspect a concussion, the Mayo Clinic recommends acetaminophen (Tylenol and other brands) and recommends avoiding pain medications that thin the blood, such as aspirin or ibuprofen (Advil, Motrin IB, others), as they may increase the risk of bleeding.
Other sources say not to take acetaminophen until four hours after the concussion and avoid medications such as Advil and Aleve (which thin the blood) for the first 12 hours of a concussion. We recommend that if your symptoms are worsening, go to the ER - if the doctors suspect bleeding in the brain they will do scans to rule out that possibility.
Once any concern about a brain bleed is past, over-the-counter medications are okay to use for symptoms of a concussion.
The full range of over-the-counter pain medications is sometimes part of treatment for what is termed Post Traumatic Headache, also referred to as post-concussion syndrome. In many cases, the recommended dose of over-the-counter medications may be subtherapeutic (not strong enough) for post-concussion headaches. For example, the label on naproxen sodium (ALEVE and generic formulations) says to take one tablet (220 mg) two times daily. "However, many clinical practitioners recommend approximately 500–550 mg of naproxen sodium per dose for headache treatment."
Be aware of the problems associated with NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen, naproxen, celecoxib (Celebrex), meloxicam and aspirin. (Acetaminophen is not an NSAID). The recommended dosing on the labels may not be enough to help, and if you take too much, you've got another set of problems: "nonsteroidal anti-inflammatory drugs and aspirin can cause gastritis, gastrointestinal bleeding, increased bleeding time, and peptic ulcer disease."
Even more of a concern, "The evidence has been building for years that NSAIDs are bad for the cardiovascular system. Epidemiological studies have suggested that such drugs increase the risk for heart attacks, strokes, congestive heart failure and death."
Melatonin is produced in the body and can be supplemented with over-the-counter liquid or tablet melatonin. Melatonin acts in the body in ways that supports recovery from TBI, including decreasing neuroinflammation, reducing oxidative stress, improving mitochondrial function, and decreasing glutamate toxicity. It also has therapeutic properties; research has shown it to reduce chronic pain, migraines headaches, and anxiety. Research in Canada has found that "children with prolonged PCS and headaches had a significant response to melatonin treatment," especially for Post-traumatic headaches which are considered particularly resistant to treatment. Current trials with children and PCS headaches are using 3 mg and 10 mg doses of Melatonin.
Some professional athletes, veterans, and patients with Post-Concussion Syndrome are self-medicating with CBD products (either from hemp or marijuana) which have little or no THC, so they don't get you high. There is considerable anecdotal evidence that CBD products are helpful for headaches, insomnia, and anxiety. Our section CBD covers the research concerning CBD. Also, see the article "Why Athletes are Ditching Ibuprofen for CBD."
WebMD says that caffeine can help headaches by reducing inflammation, and ingesting caffeine along with aspirin, ibuprofen, or acetaminophen makes these over-the-counter medications work faster, better, and keep the pain away for longer.
Withdrawal from daily use of caffeine (even as little as one cup a day) can cause a headache.
Medication over-use. If you take too much of any kind of pain reliever or take it too often, you can get a rebound headache when the meds wear off, and caffeine can make a rebound headache more likely. WebMD
Future Medications Specifically for Concussions
In the future, there will be medications specifically for concussions, both for initial treatment right after the concussion, and for those with Post-Concussion Syndrome.
We know of two different concussion medications which are in clinical trials. The University of Miami, funded by a Canadian R&D firm, is in pre-clinical studies of a medication that combines CBD (cannabidiol) and another chemical, for use both right after a concussion and long-term symptoms. See our section on CBD from Marijuana or Hemp.
Oxeia Biopharmaceuticals Inc is developing a medication based on synthetic human ghrelin (OXE-103) and is in Phase 2 studies as of 2018. The medication is intended to address the brain's metabolic "energy crisis" as it responds to the concussion, with the aim of lessening metabolic dysfunction and therefore longer-term consequences of concussions. Chris Nowinski, Ph.D., CEO of the Concussion Legacy Foundation, is an advisor to Oxeia.
Medications Used in Headache (Migraine) Treatment
Chart is from Brain Neurotrauma: Molecular, Neuropsychological and Rehabilitation Aspects by Sylvia Lucas. Preventive treatment is headache treatment that is used daily when attack frequency is high.