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

Pharmacological treatment of acute mTBI symptoms has been elusive. Unaddressed symptoms, especially headache, may complicate recovery and have lingering effects if not aborted. 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. 

Retrospective review of 383 acute mTBI patients (mean age 22.4±13.3; 56% female) seen within 21 days of injury. Concussion symptoms were assessed using the Post-Concussion Symptom Scale. 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. 

Patients prescribed amitriptyline (n=250) recovered within an average of 39.7±32.7 days with a recovery rate of 100%. Within the subset of concussion patients with a history of depression (n=53), those who were prescribed amitriptyline reported a symptom score that rapidly decreased from the first week of amitriptyline use to week three. By week three, symptom scores for this patient subgroup remained below 5 out of 132 on the scale, with mean scores approximating zero by week six. 

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 complete resolution of symptoms. Our results suggest that amitriptyline is a viable pharmacological option in treating mTBI symptoms, and may prevent lingering effects in a patient subset vulnerable to prolonged recovery, those with a history of depression.