Intravenous Metoclopramide Versus Intravenous Acetaminophen for Acute Concussion Treatment

Nearly 1.5 million patients present to US emergency departments (ED) annually followinghead trauma. Many, even with a low velocity mechanism of injury, report a variety ofpost‐concussion symptoms, including headache, dizziness, and nausea. For most patients,post‐concussion symptoms will resolve after several days, though up to 1/4 will developpersistent symptomatology that can last months or years.Very few randomized studies are available to guide treatment of acute post‐concussionsymptoms. In the absence of evidence, most emergency physicians treat post‐concussionsymptoms using typical medications for the symptom ‐ thus headache is treated withanalgesic medication, nausea with antiemetics, and dizziness with medications such asmeclizine. Other symptoms commonly described as part of post‐concussion syndrome, such asfatigue, irritability, and poor concentration, are usually left untreated.Two randomized studies among ED patients who experienced head trauma were recentlycompleted at Montefiore EDs. In the first, one dose of IV metoclopramide, when comparedto placebo, improved post‐concussion syndrome both in the ED and one week later. In thisstudy, IV metoclopramide was effective against a broad range of symptoms beyond justheadache and nausea. Variables related to concentration (including concentration,remembering, and feeling like one is in a fog) were better in the metoclopramide arm atboth one hour and at one week. Similarly, variables related to emotion (including feelingmore emotional, irritability and sadness) were better in the active group. In the secondstudy, adding IV dexamethasone to metoclopramide did not result in increased or prolongedefficacy.