Objective:

To investigate the utility of amitriptyline in expediting recovery and symptom relief in acute mTBI.

Background:

Pharmacological treatment of acute mTBI symptoms have been elusive. Unaddressed symptoms, especially headache, may complicate recovery and have lingering effects if not aborted early on. Amitriptyline, a tricyclic antidepressant, is used for off-label purposes 81% of the time, including migraine prophylaxis. The research is inconclusive on the use of amitriptyline to address headache in mTBI, however a number of studies reveal beneficial effects. We have observed improvement of multiple symptoms in patients treated with amitriptyline in our clinic. 

Design/Methods:

Retrospective review of 590 acute mTBI patients (mean age 24.4±14.6; 56% female) seen within 21 days of injury. Concussion symptoms were assessed using the Post-Concussion Symptom Scale, which includes 22 individual symptoms scored from 0 (none) to 6 (severe). Statistical methods for comparing characteristics between patients on amitriptyline and those not on the medication involved using independent t-tests for continuous variables and chi-square tests for categorical variables.

Results:

Patients prescribed amitriptyline (n=386) recovered within an average of 44.4±2.2 days with a recovery rate of 100%. Total baseline symptom score was significantly higher in patients prescribed amitriptyline, compared to those not prescribed (42.3 vs. 33.8, p<0.001). History of anxiety, depression, and migraine were higher in the amitriptyline group.

Conclusions:

Data from our clinic reveals that patients presenting with more severe symptoms and a history of comorbidities considered risk factors for prolonged recovery were prescribed amitriptyline, which was beneficial in achieving full recovery defined as clearing exertion and provocative vestibular testing and complete resolution of lingering symptoms. Our results suggest that amitriptyline is a viable pharmacological option in treating mTBI symptoms, and may both enhance recovery and prevent lingering effects.