Home » Post-Concussion Syndrome: Possible Therapies

Post-Concussion Syndrome: Possible Therapies


Epsom salts

There is anecdotal evidence to suggest that good old fashioned Epsom salts (magnesium sulfate), either as part of a bath therapy or as a foot soak, is a simple, yet remarkably helpful, therapy in relieving the symptoms of post-concussion syndrome. Epsom salts

It appears Epsom salts help in concussion recovery for several reasons. According to a groundbreaking 2001 study by researchers at UCLA, [2] the biology of concussion involves a cascade of damaging calcium ion releases, which the magnesium in the Epsom salts likely helps counteract (although fundamental research on mineral supplements is typically old, and no pharmaceutical company or biochemistry department is likely going to spend big bucks promoting the use of magnesium sulfate any time soon).

Magnesium is also a known treatment for migraine and helps to promote sound sleep, and sulfates are necessary for proper brain function with respect to behavior, mood and function. Reduced sulfation has been shown in a study by researchers at the University of Birmingham (UK) to play a role in brain dysfunction, such as Parkinson's Disease.

While more research is needed specific to concussion, the use of Epsom salts may be a sensible, non-invasive, inexpensive home remedy which may help the concussed athlete with little, if any, downside risks. At the very least, floating in a bathtub reduces the strain on the brain in counter-acting the pull of gravity.

Hyperbaric oxygen 

One potential therapy that has gained recent attention is Hyerbaric Oxygen Therapy (HBO2), which involves breathing high levels of oxygen, usually 100%, at an increased pressure of at least 1.4 times greater than atmospheric pressure at sea level. The intent of HBO2 therapy is to increase the oxygenation of the blood and tissues of the patient to supraphysiological levels, based on the still unproven theory that it can return neurons in the brain adjacent to severely damaged or dead neurons to normal or near normal function through exposure to hyperbaric oxygen.[18].

A 2011 study [17] of fifteen military personnel (all previously diagnosed with traumatic brain injury) treated with forty hyperbaric oxygen treatments reported that the patients made significant improvements in injury symptoms, physical exam results, cognitive measurements, and most importantly, quality of life ratings.

A subsequent, first-of-its-kind double-blind, randomized, prospective study [18] of 50 military personnel with at least one combat-related mild traumatic brain injury treated with 30 sessions of 2.4 atmospheres absolute hyperbaric oxygen, found no significant effect on post-concussion symptoms or neurocognitive test scores.

"Given that HBO2 ... demonstrates no therapeutic value, requires long treatment series, is expensive, exposes patients to potential side effects, and has limited availability, clinical usage is not warranted for the management of symptoms of chronic mTBI at ... treatment pressure [of 2.4 atmospheres],"  the study concludes.

The authors, however, in recognition of the possibility that the dose was "excessive" (noting that most anecdotal chronic mTBI case reports and series used 1.3 atmospheres), recommended that larger, multicenter, randomized, controlled, double-blinded clinical trials be conducted at lower total oxygen doses." 

Most recently, a single center, double-blind, randomized, sham-controlled, prospective 2014 study[19] of military service members with at least one combat-related mild traumatic brain injury suffering from PCS who underwent 40, once-daily hyperbaric chamber compressions at 2.0 atmospheres found no significant improvement in concussion symptoms that could be attributed to the HBO2, findings which paralleled the results of the 2012 study.  

The study's authors viewed their findings as "particularly important" because they used the more typical treatment pressures advocated by hyperbaric clinicians.

Diet supplements don't work

There are no diet supplements that have been scientifically proven to treat or cure concussions, although that has not kept companies from trying. As a result, the U.S. Food and Drug Administration (FDA) was forced in December 2013 to issue a consumer health advisory [20] warning consumers to avoid purported dietary supplements marketed with claims to prevent, treat, or cure concussions and other TBIs "because the claims are not backed with scientific evidence that the products are safe and effective for such purposes."  The advisory warns that "even if such supplement contains no harmful ingredients, "that claim alone can be dangerous," says Gary Coody, FDA's National Health Fraud Coordinator.

"We are very concerned that false assurances of faster recovery will convince athletes of all ages, coaches, and even parents that someone suffering from a concussion is ready to resume activities before they are really ready," says Coody, who says parents need to be "watch for claims that these products can ... lessen the severity of concussions or TBIs."

"Typically," says the FDA advisory, "products promising relief from TBIs tout the benefits of ingredients such as turmeric and high levels of omega-3 fatty acids derived from fish oil."  It noted that it has been forced to send warning letters to at least two companies ikn 2012 that their products were not generally recognized as safe and effective for treating TBIs, and that unless the violations were promptly corrected, legal action could result without further notice. Both companies changed their websites and labelling. 

Most recently, the FDA issued a warning letter to Star Scientific, Inc. for marketing its product Anatabloc with claims to treat TBI.  

Note: this article describes just some of the potential therapies for treating PCS, and it is not intended to be exhaustive, nor is it intended to provide medical advice. If your child has PCS, please consult with their treating physician. 

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2.Giza CC, Hovda DA, The Neurometabolic Cascade of Concussion.  J Ath Train 2001;36(3):228-235. 

3. Reddy CC, Collins M, Lovell M, Kontos A. Efficacy of Amantadine Treatment on Symptoms and Neurocognitive Performance Among Adolescents Following Sport-Related Concussion.  J Head Trauma Rehab 2012: DOI: 10.1097/HTR.0b013e318257fbc6 (published online ahead of print)(accessed December 13, 2012).

4. Lau BC, Kontos AP, Collins MW, Mucha A, Lovell MR. Which On-Field Signs/Symptoms Predict Protracted Recovery From Sport-Related Concussion Among High School Football Players? Am J. Sports Med 2011;20(10) DOI:10.1177/0363546511410655 (published June 28, 2011 online ahead of print)(accessed November 5, 2011).

5. Alsalaheen BA, Mucha A, Morris LO, et al. Vestibular rehabilitation for dizziness and balance disorders after concussion. J Neurol Phys Ther. 2010;34(2):87-93.

6. Leddy J, et. al. A Preliminary Study of Subsymptom Threshold Exercise Training for Refractory Post-Concussion Syndrome, Clinical J of Sport Med 2010; 20(1):21-27 (doi: 10.1097/JSM.0b013e3181c6c22c).

7. Neary J. et. al. Cerebrovascular Reactivity Impairment after Sport-Induced Concussion, Med & Sci in Sports & Exercise 2011;43(12): 2241-2248.  

8. SUNY-Buffalo,  UB Specialized Exercise Regimen Shown to Relieve Prolonged Concussion Symptoms.  http://www.buffalo.edu/news/10848 (accessed December 10, 2011).   

9. Schneider K, Iverson G, Emery C, McCrory P, Herring S, Meeuwisse W. The effects of rest and treatment following sport-related concussion: a systematic review of the literature.  Br J Sp Med. 2013;47:304-307. 

10. Leddy J, Sandhu H, Sodi V, Baker J, Willer B. Rehabilitation of Concussion and Post-concussion syndrome. Sports Health: A Multidisciplinary Approach 2013;4(2):147-154,

11.  Mittenberg W, Tremont G, Zielinski R, Fichera S, Rayls K. Cognitive-behavioral prevention of postconcussion syndrome. Arch Clin Neuropsychol 1996;11(2):139-145. 

12. Al S, Sandford D. Carson A. Psychological approaches to treatment of postconcussion syndrome: a systematic review.  J Neurol Phys. Ther. 2010;34(2):87-93. 

13. Postford J, Willmott C, Rothwell A, et al. Impact of early intervention on outcome after mild traumatic brain injury in children.  Pediatrics 2001;108(6):1297-1303. 

14. Alsalaheen B, Mucha A, Morris I, et al. Vestibular rehabilitation for dizziness and balance disorders after concussion.  J Neurol Phys Ther. 2010;34(2):87-93.

15. Harmon K, Drezner J, Gammons M, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med 2013;47:15-26. 

16. Meehan W, Kids, Sports, and Concussions. (Praeger 2011). 

17. Harch P, et al. A Phase I Study of Low-Pressure Hyperbaric Oxygen Therapy for Blast-Induced Post-Concussion Syndrome and Post-Traumatic Stress Disorder. J Neurotrauma. 2011; DOI:111122062711007.

18. Wolf G, Cifu D, Baugh L, Carne W, Profenna L. The Effect of Hyperbaric Oxygen on Symptoms after Mild Traumatic Brain Injury. J Neurotrauma 2012;29:2606-2612.

19. Cifu DX, Hart BB, West SL, Walker W, Carne W. The Effect of Hyperbaric Oxygen On Persistent Postconcussion Symptoms. J Head Trauma Rehabil. 2014;29(1):11-20.

20.  Food and Drug Administration. Consumer Update: "Can A Dietary Supplement Treat A Concussion? No." December 31, 2013. accessed at http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm378845.htm

21.  Leddy JJ, Cox JL, Baker JG, Wack DS, Pendergast DR, Zivadinov R, Willer B. Exercise Treatment for Postconcussion Syndrome: A Pilot Study of Changes in Functional Magnetic Resonance Imaging Activation, Physiology and Symptoms.  J Head Trauma Rehabil 2013;28(4):241-249.

22. Cabrera Kang CM, Tusa RJ Vestibular rehabilitation: rationale and indications.  Semin Neurol 2013;33:276:85. 

23. Schneider KJ, Meeuwisse WH, Nettel-Aguirre A, et al. Cerviovestibular rehabilitation in sport-related concussion: a randomized controlled trial. Br J Sports Med 2014;48:1294-8.  

24.  Ellis MJ, Cordingley D, Vis S, Reimer K, Leiter J, Russell K. Vestibulo-ocular dysfunction in pediatric sports-related concussion. J. Neurosurgery: Pediatrics, published online, ahead of print, June 2, 2015; DOI: 10.3171/2015.1.PEDS14524.

25.  Research paper, Exercise Tolerance in Pediatric Patients with Post-Concussion Syndrome. Johnson WR, et. al. Presented at American Academy of Pediatrics National Conference and Exhibition, October 24, 2015. Washington, D.C.

26. Research paper. Vestibular Rehabilitation in Children Following Concussion. Storey E, et al. Presented at American Academy of Pediatrics National Conference and Exhibition, October 24, 2015. Washington, D.C.

Most recently updated November 24, 2015