Several drugs are often used to treat symptoms of concussion, including an epilepsy drug, gabapentin (Neurontin), amitriptyline (Elavil) and other antidepressants.
A recent study by doctors at the University of Utah in Salt Lake City examined the role of medications in the treatment of concussions. They studied 277 patients who suffered a concussion and were seen at the local sports medicine clinic. Patients were evaluated for 22 symptoms including headaches. The patients were divided into three groups: those prescribed amitriptyline or nortriptyline, those who were prescribed gabapentin, and those who were not prescribed any medication at all.
Patients who were prescribed medications tended to have more severe headaches and other symptoms. However, headaches and other symptoms decreased significantly within days after the initial visit equally in all three groups.
This study does not prove that all treatments for postconcussion syndrome are ineffective. A recent presentation by Dr. Bert Vargas of the Sports Neurology and Concussion Program at the University of Texas Southwestern Medical Center in Dallas stressed that many migraine treatments can be very effective for postconcussion headaches and other symptoms. The features of postconcussion headaches often resemble migraines and migraine medications, such as triptans (sumatriptan, or Imitrex, and other) can be very effective. Unfortunately, only 2% – 5% of patients with posttraumatic headaches receive migraine drugs. The vast majority are treated with acetaminophen or NSAIDs, such as ibuprofen or naproxen.
Botox injections have also been reported to be very effective for postconcussion headaches, which has been my experience as well. Botox injections are approved by the FDA only for the treatment of chronic migraines. However, if headaches are accompanied by migraine features a diagnosis of posttraumatic chronic migraine can validly be made and then many insurance companies will pay for this treatment.
Dr. Vargas also noted that topiramate (Topamax), which is an epilepsy drug approved for the prevention of migraines, is not a good choice for posttraumatic headaches. Topiramate often causes cognitive side effects which can worsen the concussion-related cognitive problems, including impaired memory and concentration.
