Postconcussion Syndrome Treatment & Management

Updated: Sep 24, 2018
  • Author: Eric L Legome, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Treatment

Emergency Department Care

No specific care is required in the ED. Patients with the symptom constellation consistent with postconcussion syndrome (PCS) require thorough physical and neurological examinations. A CT scan should be obtained if significant concern about intracranial hemorrhage exists, although this injury is rare in the patient presenting late with nonfocal findings at examination. [41]

  • Supportive care may include the use of nonnarcotic analgesics and antiemetics. However, there does not appear to be any medications at discharge that can prevent or hasten the resolution of PCS. Several drugs are under investigation, but none have proven to be clinically useful yet.

  • Several studies have shown that providing patients with an explanation of symptoms as well as expectations may decrease the severity and duration of postconcussive symptoms.

  • Although rare, patients may be admitted if symptoms are severe, the majority can be discharged. Several studies have revealed that patients admitted acutely after a minor head injury (MHI) may have a lower incidence of PCS and its attendant social and psychological morbidity. This finding, however, may be due to active interventions at follow-up.

  • Prompt follow-up care and reassurance may hasten resolution of symptoms. Patients should be referred to a primary care doctor, neurologist, or psychiatrist depending on their symptoms.

  • Follow-up and patient education on what to expect after minor head injuries is useful, as many patients will have symptoms for weeks after discharge. [42]

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Consultations

Rarely is consultation warranted in the ED once the diagnosis is made. Outpatient referral is the cornerstone of treatment. One study suggests that findings of early neuropsychological assessment may determine the prognosis; however, this assessment rarely is performed in the ED.

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Medical Care

Outpatient care is the cornerstone of treatment of patients with postconcussion syndrome and involves multidisciplinary teams that provide testing and treatment, including cognitive rehabilitation, psychotherapy, stress management, vocational counseling, and symptomatic treatment with medications.

  • No treatments have been proven effective, though neurotherapy or quantitative EEG biofeedback is a modality that has been shown in recent studies to improve symptoms of PCS. More controlled studies are needed at this point.

  • A neurologist, physical medicine specialist, primary care physician, or psychologist specializing in these disorders usually coordinates treatment.

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