Why patients with concussions should not be prescribed IV drips

Mild traumatic brain injury: the signature wound of war

Over the course of their lives, most service members have experienced at least one concussion and endured its lasting effects — migraines, hearing and vision impairments, insomnia, panic attacks, as well as memory and concentration difficulties. Despite being a common injury, concussions remain an invisible trauma — one that service members carry with them for a lifetime. However, despite how widespread this issue is, many service members and their families lack essential knowledge about proper treatment for mild traumatic brain injury (TBI). This lack of awareness has led to speculation, ineffective treatments, and persistent myths that prevent people from choosing evidence-based care. In this series of posts on treating mild TBI, we begin by debunking one of the most widespread myths: "When shell-shocked, you should get an IV drip."

IV drips are simply one method of administering medication — neither superior nor inferior to other options. If a patient is capable of taking oral medication, they should do so, as this is the most natural method of administration.

What are the components of brain injury mechanism?

The mechanism of brain injury consists of the following elements:

• "Waves" — similar to tides — create disproportionate pressure on the brain.
• "Turns" — the movement of mobile brain parts relative to immobile structures.
• "Countercoup" — the brain’s sudden impact against the opposite side of the skull.

All of these factors lead to the loss of connections between brain cells and cause damage that, unfortunately, remains impossible to reverse with medication. One of the major challenges in treating TBI is the blood-brain barrier (BBB) — a natural defense mechanism that prevents harmful molecules from reaching the brain but also limits the accumulation of medications. The BBB forms a protective layer around blood vessels that deliver nutrients to the brain, blocking foreign substances from entering the central nervous system.

Have you seen these medications on common treatment lists?

The following drugs are often used for TBI treatment:

• Vinpocetine;
• Citicoline;
• L-Lysine;
• Piracetam;
• Nootropil;
• Cinnarizine.

These medications lack proven efficacy in treating TBI. They are rarely used in most countries and are absent from treatment protocols. Additionally, some of these drugs may contribute to the development of other health issues.  Despite this, they remain widely prescribed in Ukraine. Although they are actively used in healthcare, their application for mild TBI treatment is inappropriate. In fact, some of them are directly associated with worsening the overall prognosis.

Which medications actually work?

Unfortunately, medications can be only used for symptom relief:

• Paracetamol and other painkillers to ease headaches.
• Ondansetron for nausea.
• Medications for sleep and anxiety management, as needed.

What other treatments help?

Here are some useful strategies for recovery:

• Limit screen time and reduce exposure to light and noise.
• Sleep in a quiet, cool, and dark room.
• Gradually return to physical activity 
• Engage in cognitive exercises to maintain memory and brain function. Activities like solving a Rubik’s cube, assembling jigsaw puzzles, or reciting poems and songs from memory can be beneficial;
• Psychotherapy (if needed).