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“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Clinical Pearl Wednesday #140

Fatigue Tired Out Tired Sleep  - Elf-Moondance / Pixabay

Have a patient who has had a recent head injury? Do you suspect a post-concussion syndrome?

Concussion symptoms generally resolve quickly in most patients. Often it will only take a few days for the symptoms to subside, but in a handful of patients, the symptoms can linger for months.

Some of the most common symptoms include headache, neck pain, and insomnia. These usually resolve first. Unfortunately, fatigue tends to be the major symptom that likes to linger around for a prolonged period of time though.

To treat the physical symptoms, over the counter medications such as ibuprofen and Benadryl will help with the headaches and sleep. Sometimes you need to prescribe something stronger for sleep such as hydroxyzine or Ambien, but usually 25-50mg of Benadryl does the trick.

Fatigue on the other hand can be difficult to treat. The fatigue can be very bothersome in high functioning patients, therefore a reasonable approach to treating the fatigue that a top neurologist in my area recommends for post-concussion patients is modafinil. This medication typically will boost energy without the adverse effects of stimulants. Additionally, it does not tend to increase blood pressure or heart rate at any significant level.

Be cautious though, as this medication can develop dependency, therefore only use this for a short period of time and provide adequate patient education.

4 Responses

  1. Years ago my son who played football suffered multiple head bumps in the course of a month. He had many symptoms of post concussion syndrome. At one point his lack of sleep and his emotional fatigue made him suicidal (didn’t know this till months later). I desperately searched for an answer and came across a study that was in progress. I reached out to the group doing the study and they suggested melatonin 10 mg every night for no less than a month. By week two my fun loving son was back. By months end he was 100 percent back to normal that’s when he told me that the fatigue alone made him suicidal and that he actually was driving at a high speed to crash into a tree because he couldn’t take it. Then he realized it wasn’t worth it. Post concussion syndrome is def serious and the fatigue can be aweful. Thankfully he fully recovered and has been great since. But search studies and you will find many on post concussion syndrome and melatonin. Thanks for the post

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