Treatment and Management

Management of Symptoms Beyond the Initial Period

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Clinical Cornerstone:

• In most cases of concussion, symptoms go away on their own and most people will recover well within 4-6 weeks.

• Case management of persistent symptoms includes monitoring and reassessment. Of concern is the overlap between persistent concussion symptoms, the symptoms associated with traumatic mechanisms of injury (e.g. anxiety, depression), and the symptoms of comorbid conditions (e.g. headache, whiplash). Clinical reasoning should be used to tailor clinical management to the patient’s individual needs and goals.
   

Physical Symptoms (Headache, Non-specific neck pain)

• Consider patient education (e.g., stimulus control, environment modification)

• Consider behaviour modification (e.g. sleep hygiene)

• Consider pharmaceutical interventions for acute pain and prevention of headache attacks

• Consider non-pharmacological interventions (manual therapies, low-level laser therapy) for non-specific neck pain

Sleep Disturbance / Fatigue

• Consider patient education (e.g. prevalence).

• Consider behaviour modification (e.g. sleep hygiene, activity-to-tolerance)

• Consider mental health interventions (e.g. CBT, stress management)

• Consider non-pharmacological interventions (e.g. melatonin, zinc, magnesium)

Mental Health Symptoms

• Consider patient education (e.g. symptoms, prevalence, treatment options and resources).

• Consider mental health interventions (e.g. Cognitive Behavior Therapy (CBT))

• Consider referral (e.g. primary care provider, emergency department)

Cognitive Symptoms

• Consider patient education (e.g., reassurance of expected recovery within first three months)

• Consider behaviour modification (e.g. work/school accommodations, sleep hygiene)

• Consider mental health interventions (e.g. CBT, stress management)

• Consider referral (e.g. primary care provider, neuropsychology)

Vestibular Symptoms

• Recommend sub symptom-threshold aerobic exercise

• Consider cervicovestibular rehabilitation exercises for symptoms that persist longer than 10 days (e.g. non-provocative ROM exercises, postural stability exercises, craniovertebral flexor and extensor exercises, vestibulo-occular (VOR) retraining)

• Consider behavior modification (e.g. microbreaks, work/school accommodations)

• Consider canalith manouvers (e.g. Epley Manouver or Brandt-Daroff exercises)

• Consider referral (e.g. primary care provider, neuropsychology)