A Systematic Review of Treatments for Mild Traumatic Brain Injury in Adults

Context: Up to 15% of concussed patients experience persistent symptoms and functional impairment following injury. This is often related to headaches, dizziness, imbalance, and visual disturbances. Objectives: To perform a systematic review of the evidence for interventions used to manage postconcussion symptoms in working-aged adults falling within the headache-migraine, ocular, and vestibular postconcussion symptom cluster subtypes. Methods: A literature search was performed according to the PRISMA statement. PubMed, OVID, Cochrane Central, PEDro, OSTEMED, and the grey literature checklist were searched from the dates of creation of each database through December 29, 2020. The outcome measures were compared by generating the standardized mean difference (SMD) with 95% confidence intervals. GRADE (Grading of Recommendations, Assessment, Development and Evaluation) was used to rate the overall quality of the evidence. Results: The literature search identified 496 candidate studies. After removing duplicates, 352 studies remained. The titles and abstracts of the remaining studies were screened for eligibility and 343 studies were excluded. The full text of the remaining nine studies was assessed for eligibility and risk of bias. None of these studies was excluded. This left nine studies for qualitative and quantitative analysis. Conclusions: Moderate-quality evidence suggests 4 interventions show promise for treating adults with headache-migraine, ocular, and vestibular postconcussion subtype symptoms.