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From the Field of Play to the Field of Combat: A Review of the Pharmacological Management of Concussion

Petraglia, Anthony L. MD*; Maroon, Joseph C. MD; Bailes, Julian E. MD§

doi: 10.1227/NEU.0b013e31824cebe8
CNS University of Neurosurgery

Traditionally, the medical management of concussion has involved close observation and physical and cognitive rest. Most postconcussive symptoms resolve spontaneously and require only conservative treatment. However, some patients have prolonged recoveries and may benefit from treatment with medications. Some naturally occurring compounds demonstrate multimechanistic neuroprotective properties and may be potential treatment considerations. For the most part, however, current treatments are symptom based for those with persistent postconcussive symptoms. The evidence supporting the various pharmacologic treatments in concussion is equivocal. The choice of which medication to use for a patient depends on the symptom characteristics, and each decision should be made on an individual-case basis. There is a need for well-designed trials investigating the efficacy of various medical therapies.

ABBREVIATIONS: PCS, postconcussion syndrome

PPCS, prolonged postconcussion syndrome

PTSD, posttraumatic stress disorder

SSRI, selective serotonin reuptake inhibitor

TBI, traumatic brain injury

*Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York

Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

§Department of Neurosurgery, NorthShore University Health System, Evanston, Illinois

Correspondence: Anthony L. Petraglia, MD, Department of Neurosurgery, University of Rochester Medical Center, 601 Elmwood Ave, Box 670, Rochester, New York 14642. E-mail:

Received August 29, 2011

Accepted January 11, 2012

Copyright © by the Congress of Neurological Surgeons