Managing post-traumatic symptoms
| Symptom | Diagnosis | Treatments |
|---|---|---|
| Cognitive impairments | General Measures | Cognitive 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 treatments | Dopaminergic medications: for example, methylphenidate and amantadine83 Cholinergic medications: for example, donepezil and rivastigmine83 | |
| Psychiatric problems | Depression Anxiety | Psychological therapies for example, cognitive-behaviour therapy102 103 Medications: SSRIs (in particular sertraline and citalopram)104–106 Education Treat underlying sleep disturbance Treat underlying endocrine disturbance |
| Headache | Migraine or probable migraine | Treatment as for primary migraine (including lifestyle measures, acute and prophylactic treatment)107 (consider greater occipital nerve injection108) |
| Tension type headache | Simple analgesics. Prophylactic treatment, for example, amitriptyline or alternative tricyclic antidepressant | |
| Cervicogenic | Physiotherapy109 Nerve blocks110 | |
| Medication overuse | Reduce medication overuse. Avoid long-term use of opiates. Simple analgesics no more than two headache days per week. | |
| Dizziness | Benign paroxysmal positional vertigo | Repositioning manoeuvres.111 Physiotherapy |
| Migrainous vertigo | Migraine 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 dizziness | Vestibular rehabilitation112 | |
| Sleep disturbance | Insomnia | Cognitive 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 apnoea | Continuous positive airway pressure | |
| Daytime sleepiness | Modafinil115 | |
| Fatigue | Treat underlying depression Treat underlying sleep disturbance Treat underlying endocrine disturbance116 Bright light therapy117 Physical conditioning programmes118 119 |
SSRI, selective serotonin reuptake inhibitor.