Table 1

Managing post-traumatic symptoms

Cognitive impairmentsGeneral MeasuresCognitive rehabilitation,96 ideally in the context of a holistic rehabilitation programme.
Computer based neuropsychology training97–99
Treat underlying depression100 101
Treat underlying sleep disturbance
Treat underlying endocrine disturbance
Pharmacological treatmentsDopaminergic medications: for example, methylphenidate and amantadine83
Cholinergic medications: for example, donepezil and rivastigmine83
Psychiatric problemsDepression
Psychological therapies for example, cognitive-behaviour therapy102 103
Medications: SSRIs (in particular sertraline and citalopram)104–106
Treat underlying sleep disturbance
Treat underlying endocrine disturbance
HeadacheMigraine or probable migraineTreatment as for primary migraine (including lifestyle measures, acute and prophylactic treatment)107 (consider greater occipital nerve injection108)
Tension type headacheSimple analgesics.
Prophylactic treatment, for example, amitriptyline or alternative tricyclic antidepressant
Nerve blocks110
Medication overuseReduce medication overuse. Avoid long-term use of opiates. Simple analgesics no more than two headache days per week.
DizzinessBenign paroxysmal positional vertigoRepositioning manoeuvres.111
Migrainous vertigoMigraine treatment as above, first-line propranolol.
Central vestibular system problems (ie, injury to the central nervous system sections of the vestibular system)Vestibular rehabilitation112
Non-specific post-traumatic dizzinessVestibular rehabilitation112
Sleep disturbanceInsomniaCognitive behavioural therapy for insomnia113
Sleep hygiene measures (eg, remove electronic equipment from bedroom, reduce light and noise disturbance, etc)
Nocturnal hypnotics (use with caution due to risk of impairing cognitive functions)114
Obstructive sleep apnoeaContinuous positive airway pressure
Daytime sleepinessModafinil115
FatigueTreat underlying depression
Treat underlying sleep disturbance
Treat underlying endocrine disturbance116
Bright light therapy117
Physical conditioning programmes118 119
  • SSRI, selective serotonin reuptake inhibitor.