NSAID Use Is Not Associated With Persisting Symptoms in Adolescent Concussion

Objective: To investigate the relationship between injury factors, nonsteroidal anti-inflammatory medication (NSAID) use, and concussion outcomes. Design: Prospective cohort. Participants: Adolescents (N = 118) ≤14 days of concussion seen at a sports medicine center between November 2020 and May 2025. Independent Variable: Participants who reported ibuprofen and/or naproxen use were assigned to the “NSAID use” group, all others were assigned to the “No NSAID use” group. Main Outcome Measures: Symptom severity, medical history, and medication use information were collected. The development of persisting symptoms after concussion (symptoms > 28 days, [PSaC]) was monitored via time to symptom resolution. Results: We enrolled 118 participants with concussion (15.4 ± 1.7 years, 54% female, 8.4 ± 3.1 days postinjury): 29 (25%) reported taking NSAIDs (n = 24 ibuprofen, n = 3 naproxen, n = 2 ibuprofen/naproxen) before their evaluation. Those who reported NSAID use were evaluated sooner (7.4 ± 2.8 vs 8.7 ± 3.2 days postinjury; P = 0.05), weighed less (57.2 ± 11.0 vs 63.5 ± 17.0 kg; P = 0.06), and had more severe symptoms (59.9 ± 32.6 vs 39.3 ± 22.2; P < 0.001). More participants who reported NSAID use sustained a sport-related concussion (93% vs 73%; P = 0.02), and fewer participants who reported NSAID use started physical activity before evaluation (17% vs 39%; P = 0.03). Severe symptoms were associated with NSAID use (OR = 1.03; 95% confidence interval [CI], 1.01-1.05). Non–sport-related injuries (OR = 0.27; 95% CI, 0.08-0.91) and higher symptom severity (OR = 1.02; 95% CI = 1.00, 1.04) were associated with greater odds of PSaC, but NSAID use was not (OR = 0.62; 95% CI, 0.19-1.97). Conclusions: In adolescents, NSAID use was associated with more severe symptoms but not PSaC. To optimize clinical guidance, future research should further evaluate the role of NSAIDs in concussion recovery.