TABLE 3

Medications and mild head injury

SymptomMedication (dose range)Comment/cautions
Headache
    AcuteSimple analgesics
  • Paracetamol (1 g QID)

May induce paradoxical or rebound headache with prolonged use
Non-steroidal anti-inflammatory drugs
  • Diclofenac (100–150 mg/day)

Gastric adverse effects
Tricyclic antidepressants
  • Amitriptyline (10–50 mg nocte)

May be poorly tolerated (sedation, psychomotor slowing)
    Longer term
  • β-blockers

May increase fatigue
    (i) Prophylaxis “vascular” (migrainous) or tension type (see table 2)
  • Propranolol (20–160 mg /day)

Antiepileptics
  • Sodium valoproate (200–1600 mg/day)

  • Gabapentin (300–1800 mg/day)Pizotifen (0.5–2.0 mg/day)

Sedative adverse effects
    (ii) Attack relatedTriptans
  • Sumatriptan (25–100 mg/attack)Analgesics (see acute headache above)

Caution when combined with SSRIs
Anxiety
    AcuteBenzodiazepine
  • Lorazepam (0.5 mg prn – tds)

  • Clonazepam (0.5 mg prn – tds)

Short term use only, may impair recovery
    ChronicSSRIs
  • Citalopram (10–40 mg mane)

  • Fluoxetine (10–40 mg mane)

Serotonin syndrome, gastrointestinal adverse effects
Depression Psychostimulant
  • Methylphenidate (10–30 mg nocte)

Tachycardia, insomnia, gastrointestinal adverse effects
SSRIs
  • Citalopram (10–40 mg mane)

  • Fluoxetine (10–40 mg mane)

Long half-life, risk of interactions
Tricyclic antidepressants
  • Nortriptyline (10–50 mg nocte)

Better tolerated than amitriptyline
Insomnia (initial) (if not responsive to non-drug interventions)Benzodiazepine
  • Temazepam (10–20 mg nocte)

Short term use only, may impair recovery
Cyclopryrrolone
  • Zopiclone (7.5–15 mg nocte)

Tricyclic antidepressants
  • Nortriptyline (10–25 mg nocte)

Major tranquillizers
  • Quetiapine (25–75 mg nocte)

May impair recovery
Fatigue/cognitive slowingPsychostimulants
  • Methylphenidate (10–30 mg mane)

  • Modafinil (200–400 mg mane)

Dopaminergic agents
  • Bromocriptine (1.25–5 mg/day)

  • Levodopa (50–600 mg/day)

Cholinesterase inhibitors
  • Donepezil (5–10 mg nocte)

Mania/psychosisMajor tranquillizers
  • Haloperidol (1–3 mg/day)

  • Quetiapine (50–400 mg/day)

  • Risperidone (1–4 mg/day)

May retard cognitive recovery
 Extrapyramidal adverse effects
 Sedative adverse effects
 Weight gain