Treatment of Post-Concussion Headache

Initial Pharmacologic Management

The American Academy of Pediatrics recommends ibuprofen 400-800 mg every 6 hours as first-line treatment for acute post-concussion headache, with acetaminophen 1000 mg as an alternative for patients who cannot tolerate NSAIDs 1
Naproxen sodium 275-550 mg every 2-6 hours is an equally effective NSAID alternative for acute post-concussion headache 1
Acetaminophen 1000 mg should be reserved for patients with NSAID contraindications, though it is generally less effective when used alone 2, 3, 1

The American College of Emergency Physicians recommends beginning treatment early in the headache phase for maximum effectiveness, as waiting until pain becomes severe reduces medication efficacy 1
The American Academy of Neurology recommends limiting acute medication use to no more than twice weekly to prevent medication overuse headache 2, 3, 1

The American Gastroenterological Association recommends adding metoclopramide 10 mg or prochlorperazine as adjunctive therapy for nausea accompanying post-concussion headache 1
The American Academy of Pediatrics recommends nonopioid analgesia, such as ibuprofen or acetaminophen, for children with post-concussion headache, along with counseling about analgesic overuse risks 2, 3

The American Academy of Pediatrics recommends avoiding aspirin in children and adolescents due to Reye's syndrome risk 1
The American Academy of Pediatrics recommends clinical observation and consideration of head CT for children with severe or worsening headache after concussion to evaluate for intracranial complications 2, 3

The American College of Physicians recommends never using opioids for post-concussion headache, as they lead to dependency, rebound headaches, and loss of efficacy without providing superior pain relief 5, 6, 1

The American College of Sports Medicine recommends graded aerobic exercise, with gradual increases in intensity performed at least once weekly for 4 weeks, as an adjunct to pharmacologic treatment for post-concussion headache 7
The American Physical Therapy Association recommends physical therapy, particularly when cervicogenic features are present, for management of post-concussion headache 5, 7